Federal & State Regulations | HIPAA - Massachusetts | J. J. Keller® Compliance Network

State Info

Summary of differences between federal and state regulations

Federal HIPAA portability provisions limit exclusions for preexisting conditions; prohibit discrimination against employees and dependents based on their health status; and allow a special opportunity to enroll in a new plan to individuals in certain circumstances.

States are allowed to go beyond the federal requirements. Massachusetts has some of its own laws on health insurance portability and accountability.

As of January 1, 2009, Minimum Creditable Coverage is a standard that the health insurance of a Massachusetts adult must meet. This standard includes certain benefits involving preventative and primary care, emergency services, hospital stays, outpatient services, prescription drugs, and mental health services.

Specifically, a plan must:

Cover prescription drugs.
Cover 3 regular doctor visits and check-ups for an individual or 6 for a family before any deductibles.
Cap the deductible at $2,000 for an individual or $4,000 for a family each year.
Cap out-of-pocket spending for non-Rx health services at $5,000 for an individual or $10,000 for a family each year if you have a deductible or co-insurance).
Not cap total benefits for a sickness or for each year; and more.