For example, a plan can’t limit coverage for maternity services to an employee or a spouse, but exclude that coverage for covered dependent children.
Coverage for all individuals must include all core services and the broad range of benefits. MCC may consist of a single plan or a combination that together meet the standards.
Mental health and substance abuse services.Medical/surgical care, including preventive and primary care.Maternity and newborn care, including prenatal care, post-natal care, and delivery and inpatient maternity services.Hospitalization, including - at a minimum - inpatient services typically provided at an acute care hospital for benefits covered under the member's subscriber certificate or plan description.Diagnostic imaging and screening procedures, including X-rays.Ambulatory patient services, including outpatient, day surgery and related anesthesia.Within these services, the plan must cover a broad range of services that include the following: To qualify as MCC, a plan must cover four core services: physician services, inpatient acute care, day surgery, and diagnostic procedures and tests. TPAs typically ask employers for this attestation in late summer or early autumn, well before the January reports are due. Any self-insured employer - including one with different vendors for the medical plan and carved-out prescription drug or mental health benefits - has to base its attestation on the combined features of the medical plan and the carved-out benefits. TPAs providing MA 1099-HC reporting services commonly require self-insured plan sponsors to attest that their plans meet MCC standards. Even if the coverage is actuarially equivalent, the Health Connector won't approve a plan that fails to provide the core services discussed below. Actuarial equivalence doesn't guarantee MCC certification approval. While not required (unless requested), the attestation may expedite the application process. The application may include an actuarial attestation showing the coverage has equal or greater value than a Health Connector bronze plan. If a plan received certification for 2019 or later and hasn’t expanded any deviation from MCC standards, resubmission is not necessary and not welcomed. Any application must identify a deviation from MCC standards. Applications for other years won't be accepted for review in 2021.
Applications for the 2021 plan year must be submitted by Nov. They only need to distribute Forms 1099-HC and report to the DOR.Ī plan that fails to meet the core or alternative MCC standards may submit an MCC Certification Application to the Health Connector. Employers that self-certify don’t need to complete or submit any special form or filing. Plan sponsors whose insurance vendors don’t do this can review plan provisions and self-certify that the plan qualifies as MCC if it meets all the requirements outlined below. Insurers subject to Massachusetts regulation must determine and disclose MCC status. Reporting may be more complex for employers that have multiple TPAs for a single plan. However, MCC reporting falls to the employer if its health plan is from an insurer that isn’t subject to the state’s laws and won’t agree to file the reports. Insurers subject to Massachusetts regulation must comply with the reporting requirements. While the MCC reporting law applies to plan sponsors and state-regulated insurers, most self-funded employers rely on third-party administrators (TPAs) to determine MCC status, distribute the forms and file the DOR report. 31 after the close of a coverage year, health plans that provide MCC must distribute Form MA 1099-HC to covered individuals who reside in Massachusetts and report this information to the state Department of Revenue (DOR).
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