State and Territory Updates

Massachusetts

February 27, 2024

Massachusetts Paid Family and Medical Leave (PFML) Private Plans Reporting Requirements

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The Department of Family and Medical Leave (DFML) recently announced that all approved MA PFML private plans (fully insured and self-insured plans) are required to furnish required data to DFML for the 2024 fiscal year. The submission form will open online on July 1, 2024, and the deadline for submission is August 31, 2024.

As background, employers with approved MA PFML private plans are required to maintain reports, information and records related to their approved plan and furnish required data to DFML on request. DFML is now collecting information from each private plan for the period from July 1, 2023, to June 30, 2024.

For fully insured MA PFML private plans, the insurer is responsible for submitting this report. Employers who sponsor self-insured and self-administered MA PFML private plans are responsible for submitting the report. If the private plan is self-insured and an insurer or TPA is administering the plan, the employer should consult their administrator regarding report submission.

DFML indicated that it may withdraw approval of a private plan for refusing or failing to submit a required report. Employers who sponsor MA PFML private plans should work with their insurer or TPA or work internally to gather the required data and submit the report on time.

For further information, please refer to this MA PFML site.


January 17, 2024

Reminder: Massachusetts Individual Mandate Form MA 1099-HC Due January 31

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Massachusetts requires its residents (over the age of 18) to carry minimum creditable coverage (MCC) or pay a penalty. It is a similar requirement to the now-repealed ACA Individual Mandate; however, a MCC determination involves a more in-depth review. Employers providing MCC to Massachusetts residents must distribute Form MA 1099-HC to them and submit reporting electronically to the Department of Revenue (DOR) by January 31, after the end of the medical plan year. However, employers are not required to offer MCC, and there's no penalty if the coverage the employer offers does not meet the MCC standard. If an employer is unsure if its plan is considered MCC, the employer can request the Health Connector to make the determination.

For fully insured plans issued in MA, the insurers generally administer these requirements on behalf of the employers. Employers with self-insured (including level-funded) plans and non-Massachusetts employers are required to complete the distribution and filing requirements themselves. Note that Form MA 1099-HC only needs to be sent to primary enrollees and does not also need to be sent to dependents. Failure to distribute and file Form MA 1099-HC may result in a penalty of $50 per individual, up to a maximum of $50,000.

Covered employers: All employers with at least one Massachusetts-resident employee must comply with the Form MA 1099-HC requirement. Employers can obtain draft copies of Form 1099-HC on the DOR website.

Due date: January 31, following the end of the medical plan year.

Information reported on MA Form 1099-HC: A Form 1099-HC indicates the months that the employees and any dependents were enrolled in MCC in the reporting year.

Filing method: Employers must submit Form MA 1099-HC information to DOR electronically in properly formatted XML through MassTaxConnect. For additional information about how to file Form MA 1099-HC information, please refer to the state site: Submitting Information to DOR.

The Form MA 1099-HC needs to be sent only to the primary subscriber.

Mass Healthcare - Frequently Asked Questions for Employers »
Health Connector - Employer Advisory »
Health Connector - HDHPs and MCC Requirements »


December 05, 2023

MA PFML 2024 Poster and Notices Updated

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The Department of Family and Medical Leave (DFML) recently released the 2024 Paid Family Medical Leave (PFML) workplace posters, model notices, and rate sheets to reflect the 2024 rates in several languages. The poster and notices must be available in English and each language that is the primary language of five or more individuals in an employer's workforce if these translations are available from DFML.

All employers (including employers with private or self-insured plans) are required to distribute these updated notices to current employees annually and new employees who start their employment on or after January 1, 2024. Additionally, all Massachusetts employers with a physical work location must display a poster in a location where it can be easily read. All the required notices and posters can be found here.

For the MA PFML 2024 premium rate and maximum benefit amount information, see the article published in the October 10, 2023, edition of Compliance Corner.

Covered employers should review the updated posters and notices, display the workplace poster, and distribute the notice to their employees timely.

2024 PFML Employer Workplace Notices and Posters »


October 24, 2023

Update to MA PFML Coordination of Benefits “Topping-Off” Rules

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Recent legislative amendments will allow employees to supplement (i.e., "top off") benefits received from Massachusetts’ Paid Family and Medical Leave (MA PFML) with any accrued and available paid leave (e.g., sick time, vacation, PTO, personal time) starting with applications filed on or after November 1, 2023.

The combined weekly PFML benefits and supplemented paid leave, whether through an employer’s short-term disability/long-term disability policies or the employee’s PTO, cannot exceed the employee’s average weekly wage. Employers will be responsible for monitoring and ensuring that the combined weekly sum of employer-provided paid leave benefits and PFML benefits does not exceed an employee’s average weekly wage. If the application is filed on or after November 1, 2023, applications filed retroactively for a leave that began before November 1, 2023, are also subject to the new “top off” rule.

Previously, employers who offered the MA PFML program through a private plan had the option to allow their employees to “top off” the benefits from the private plan with accrued paid leave. With the new legislative amendment, private plan employers are now required to provide employees with the top-off option.

For applications filed before November 1, 2023, employees are not allowed to use accrued paid leave on the same days that they are receiving PFML benefits. Employees’ accrued paid leave can only be used during the seven-day unpaid waiting period before the MA PFML benefits begin.

This is a welcome change for employees. Employers should be aware of this important update and work with their payroll division to create an internal procedure, such as the process to calculate the accrued paid leave to supplement MA PFML benefits at an employee’s request. The department has provided helpful information and FAQs regarding this update on the site below.

Department of Family and Medical Leave »


October 10, 2023

2024 Paid Family and Medical Leave Premium Rate and Maximum Weekly Benefit Announced

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The Massachusetts Department of Family and Medical Leave announced the premium rates and maximum weekly benefit amount for the Massachusetts Paid Family and Medical Leave (MA PFML) program beginning January 1, 2024.

The total 2024 MA PFML premium contribution for employers with 25 or more employees who work in Massachusetts is 0.88% of eligible wages. For employers with fewer than 25 employees who work in Massachusetts, the 2024 MA PFML premium contribution is 0.46% of eligible wages. The employee's contribution share is 0.46% of eligible wages (0.28% for medical leave and 0.18% for family leave) in 2024. For employers with 25 or more employees in Massachusetts, the employer contributes the difference between the total premium and employee contributions. For employers with 25 or fewer employees in Massachusetts, no employer contribution is required.

The maximum weekly benefit an eligible employee can receive in 2024 is $1,149.90/week, an increase from the 2023 maximum of $1,129.82.

MA PFML program requires the following actions from covered employers:

  1. Provide notice of the new contribution rate to current employees.
  2. Provide written notice about the PFML benefits to new employees within 30 days of hire.
  3. Display the updated workplace poster at their workplace in a location where it can be easily read.

The department has not yet published its model notices and poster. Employers can retrieve the model notices and poster from this site and learn about the notices and poster from this site.

MA PFML applies to most employers, including out-of-state employers, with at least one employee working in Massachusetts. The MA PFML program provides eligible employees with a portion of their wages while taking time off to bond with a child, care for a family member with a serious health condition or handle personal matters when a family member is deployed abroad on active military service.

Employers with employees in Massachusetts should ensure that their MA PFML payroll systems and MA PFML policies and communication materials reflect these new changes. For more information, please ask your advisor for a copy of our Massachusetts Paid Family and Medical Leave: A Guide for Employers publication.

PFML Contribution Rates »

PFML Overview and Benefits »


September 26, 2023

2024 Individual Mandate Coverage OOP and Deductible Minimum Creditable Coverage (MCC) Limits

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The Massachusetts Individual Mandate requires each Massachusetts resident to have health coverage that meets the Minimum Creditable Coverage (MCC) standards set by the Commonwealth Health Insurance Connector (Connector) or pay a penalty through their state tax returns. The Connector has announced the 2024 deductibles and out-of-pocket maximum limits for MCC. The 2022, 2023, and 2024 limits are summarized below.

Although employers are not required to provide MCC for their Massachusetts employees, insurers, or in some cases employers, are required to complete Form 1099-HC, which indicates whether a plan provides MCC or not and distribute the form to their Massachusetts employees. The same form must then be submitted to the state Department of Revenue (DOR) by January 31, following the plan year.

Additionally, employers with six or more employees who work in Massachusetts are required to submit an annual report entitled the Health Insurance Responsibility Disclosure (HIRD) form, where MCC status is also reported, by December 15. You can find additional information in the November 8, 2022, edition of Compliance Corner, the FAQ section.

Therefore, employers who have employees in Massachusetts should be aware of the 2024 MCC limits.

Deductible Limits 2024 2023 2022
Employee-only tier deductible $2,950 $2,850 $2,750
Employee-only tier separate Rx deductible $360 $350 $340
Family tier deductible $5,900 $5,700 $5,500
Family tier Rx deductible $720 $700 $680
Maximum Out-of-Pocket (OOP) Limits 2024 2023 2022
Employee-only tier OOP max $9,450 $9,100 $8,700
Family tier OOP max $18,900 $18,200 $17,400

Bulletin 03-23. The MCC Regulations for Calendar Year 2024 »
Bulletin 02-22. The MCC Regulations for Calendar Year 2023 »
Bulletin 06-21. The MCC Regulations for Calendar Year 2022 »
Mass Healthcare: Frequently Asked Questions for Employers, Form MA 1099-HC »


July 18, 2023

Behavioral Health Access and Crisis Intervention Trust Fund Surcharge

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Massachusetts enacted the new Behavioral Health Access and Crisis Intervention Trust Fund surcharge, which is a surcharge on certain payments made to Massachusetts acute hospitals and ambulatory surgical centers (ASCs). The surcharge requirement is applied to both fully insured and self-insured plans. The insurers for fully insured plans and TPAs for self-insured plans where a TPA makes payments to ASCs are directly responsible for administering the payments with the Massachusetts Executive Office of Health and Human Services. If a self-insured plan pays claims directly to hospitals and ASCs, then the plan sponsor (generally, the employer) is the surcharge payer.

For further information, the Surcharge FAQ below outlines the details of the surcharge requirement.

Mass. Behavioral Health Access and Crisis Intervention Trust Fund Site »
Surcharge FAQ »
101 CMR 516.00 »

Employers sponsoring a health plan that covers individuals in Massachusetts should be aware of the surcharge and work with their carrier or TPA to ensure compliance.


December 06, 2022

MA PFML 2023 Poster and Notices Updated

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The Department of Family and Medical Leave (DFML) recently released the 2023 Paid Family Medical Leave (PFML) workplace posters, model notices and rate sheets to reflect the 2023 rates in several languages. The poster and notices must be available in English and each language that is the primary language of five or more individuals in an employer's workforce if these translations are available from DFML.

All employers (including employers with private or self-insured plans) are required to distribute these updated notices to current employees annually and new employees who start their employment on or after January 1, 2023. All the required notices and posters can be found here.

For the MA PFML 2023 premium rate and maximum benefit amount information, see the article published in the November 8, 2022, edition of Compliance Corner.

Covered employers should review the updated posters and notices and display the workplace poster and distribute the notice to their employees timely.

2023 PFML Employer Workplace Notices and Posters »


November 08, 2022

2023 Individual Mandate Coverage OOP and Deductible Minimum Creditable Coverage (MCC) Limits

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The Massachusetts Individual Mandate requires each Massachusetts resident to have health coverage that meets the Minimum Creditable Coverage (MCC) standards set by the Commonwealth Health Insurance Connector (Connector) or pay a penalty through their state tax returns. The Connector has announced the 2023 deductibles and out-of-pocket maximum limits for minimum creditable coverage (MCC). The 2021, 2022 and 2023 limits are summarized below.

Although employers are not required to provide MCC for their Massachusetts employees, insurers, or in some cases employers, are required to complete Form 1099-HC that indicates whether a plan is MCC or not and distribute the form to their Massachusetts employees. The same form must then be submitted to the state Department of Revenue (DOR) by January 31, following the plan year.

Additionally, employers with six or more employees who work in Massachusetts are required to submit an annual report, entitled the Health Insurance Responsibility Disclosure (HIRD) form, where MCC status is also reported, by December 15. You can find additional information in the FAQ section of this Compliance Corner.

Therefore, employers who have employees in Massachusetts should be aware of the 2023 MCC limits.

Deductible Limits 2023 2022 2021
Employee-only tier deductible $2,850 $2,750 $2,700
Employee-only tier separate Rx deductible $350 $340 $300
Family tier deductible $5,700 $5,500 $5,400
Family tier Rx deductible $700 $680 $660

 

Maximum Out-of-Pocket (OOP) Limits 2023 2022 2021
Employee-only tier OOP max $9,100 $8,700 $8,550
Family tier OOP max $18,200 $17,400 $17,100

 
Bulletin 02-22. The MCC Regulations for Calendar Year 2023 »
Bulletin 06-21. The MCC Regulations for Calendar Year 2022 »
Bulletin 05-20. The MCC Regulations for Calendar Year 2021 »
Mass Healthcare: Frequently Asked Questions for Employers, Form MA 1099-HC »


November 08, 2022

MA PFML 2023 Premium Rate and Maximum Benefit Amount Announced

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The Department of Medical and Family Leave recently announced that the 2023 MA PFML premium contribution is of an employee's eligible wages, which is a decrease from the 2022 premium rate of 0.68%. The allocation of employer and employee contributions is determined based on the number of employees who work for the employer in Massachusetts. For employers with 25 or more employees in Massachusetts, the employee's contribution share is 0.11% of eligible wages for an employee's family leave and up to 0.208% of eligible wages for an employee's medical leave contributions. The employer contribution share is 0.312% of the total 0.63% premium. For employers with fewer than 25 employees in Massachusetts, the employee's contribution share is 0.318% of the total 0.63% premium, and there is no required employer contribution.

The maximum benefit payment an eligible employee can receive in 2023 is an increase from the 2022 maximum of $1,084.31/week.

Employers with employees in Massachusetts should ensure that their PFML payroll systems and PFML policies and communication materials reflect these changes.

2023 Contribution Share »
2023 Maximum Weekly Benefits »
MA PFML Employer's Site »


November 08, 2022

Reminder: MA HIRD Form Is Available on November 15 and Due December 15, 2022

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The Health Insurance Responsibility Disclosure (HIRD) form is a state reporting requirement in Massachusetts that applies to in-state and out-of-state employers with six or more employees working in Massachusetts. The HIRD form collects employer-level information about employer-sponsored health plans to assist MassHealth in identifying members who can participate in, and who may be eligible for premium assistance from, MassHealth. The HIRD reporting is filed through the MassTaxConnect (MTC) web portal by December 15 but is available to complete starting November 15.

To file a HIRD form, employers must log in to their MTC account and select the 'Withholding tax' account, then select the 'File health insurance responsibility disclosure' hyperlink.

MA HIRD Form FAQs and Instructions »


May 10, 2022

Massachusetts Paid Family and Medical Leave (MAPFML) Program Updated Guidance and Resources

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Recently, the Massachusetts Department of Family and Medical Leave (the 'Department') updated Massachusetts Paid Family and Medical Leave (MAPFML) program resources for employers and employees to provide additional guidance and clarifications through frequently asked questions and other online publications. The updated guidance describes how employers' paid leaves and MAPFML benefits coordinate, and how employees can check the status of their PFML payments and report other leave(s) and income on their MAPFML application forms.

Additionally, the Department added a site to explain what employers need to consider if they decide to switch between private plans and PFML state-based program, including the impact on employee leaves during the transition.

With the newly updated guidance, employers who have at least one employee working in Massachusetts should review these updated resources and consider their obligations to comply with MAPFML, including tracking MAPFML leaves and benefits along with other leaves (e.g., the federal FMLA and employer's PTO, STD/LTD and parental leaves). Moreover, employers should consider how best to inform their employees of their rights under MAPFML. Lastly, covered employers who participate in the MAPFML state-based program should collect the employees' contributions through payrolls accurately, and remit the total premiums and report quarterly to the Department via MassTaxConnect. For further information, please refer to the state's site here.

The updated MAPFML publications:

Switching Between Private Plans and PFML »
PFML Frequently Asked Questions for Employers »
Using the Employer Leave Administrator Dashboard for PFML Applications »
PFML Workforce Notifications and Rate Sheet for Massachusetts Employers »


March 15, 2022

Massachusetts COVID-19 Temporary Emergency Paid Sick Leave Is Ending on March 15, 2022

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The Executive Office for Administration and Finance recently announced that the Massachusetts COVID-19 Emergency Paid Sick Leave (MA COVID EPSL) program would be ending on March 15, 2022. The MA COVID EPSL program began on May 28, 2021. Employers have until April 29, 2022, to file their reimbursement applications for qualifying leave wages taken between May 28, 2021, and March 15, 2022. The instructions of how to apply for reimbursements can be found here.

The MA COVID EPSL program required employers whose employees work primarily in Massachusetts ('covered employers') to provide up to 40 hours of paid sick leave for COVID-19 related reasons. Covered employers can apply to the state for reimbursement for up to $850 per employee, including the cost of health benefits. Originally, the program was scheduled to expire last September. However, it was extended until the exhaustion of $100 million in program funds or until April 1, 2022. (See the articles on the background of this subject in the February 1, 2022, and June 8, 2021, editions of Compliance Corner.)

Covered employers should notify their employees of the MA COVID EPSL program's end date. Moreover, they should apply for reimbursement before April 29, 2022.

Announcement: The COVID-19 Temporary Emergency Paid Sick Leave Program is Ending March 15, 2022 »
An Act Extending COVID-19 MA Emergency Paid Sick Leave »


February 01, 2022

COVID-19 Emergency Paid Sick Leave Mandate Extended to April 1, 2022

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The COVID-19 Massachusetts Emergency Paid Sick Leave (MA EPSL) was initially scheduled to end on September 30, 2021, or until the exhaustion of $75 million in program funds, whichever came first. However, on September 29, 2021, Gov. Baker approved legislation extending Massachusetts COVID-19 Paid Sick Leave through April 1, 2022, or the exhaustion of $75 million in program funds, whichever is earlier.

As a reminder, MA EPSL requires employers to provide up to 40 hours of leave for Massachusetts employees who need leave for a covered COVID-19 related reason. All employers, except for the federal government, must provide MA EPSL, and employers may apply for reimbursement of the costs of providing MA EPSL through the Department of Revenue's MassTaxConnect website.

See the article on this subject in the June 8, 2021, edition of Compliance Corner for further details of the COVID-19 MA Emergency Paid Sick Leave.

The State's COVID-19 MA Emergency Paid Sick Leave Site »
An Act Extending COVID-19 MA Emergency Paid Sick Leave »
Revised Employee Communication Model Notice »
H. No. 3702 »


December 21, 2021

2022 Individual Mandate Coverage OOP and Deductible Minimum Creditable Coverage (MCC) Limits

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The Massachusetts Individual Mandate requires each Massachusetts resident to have health coverage that meets the Minimum Creditable Coverage (MCC) standards set by the Commonwealth Health Insurance Connector (Connector) or pay a penalty through their state tax returns. The Connector has announced the 2022 deductibles and out-of-pocket maximum limits for minimum creditable coverage (MCC). The 2021 and 2022 limits are summarized below.

Although employers are not required to provide MCC for their Massachusetts employees, insurers or, in some cases, employers are required to complete Form 1099-HR that indicates whether a plan is MCC or not and distribute the form to their Massachusetts employees. Then, the same form must be submitted to the state Department of Revenue (DOR) by January 31, following the plan year.

Additionally, employers with six or more employees who work in Massachusetts are required to submit an annual report, entitled the Health Insurance Responsibility Disclosure (HIRD) form, where MCC status is also reported, by December 15. You can find additional information in the December 7, 2021, edition of Compliance Corner.

Therefore, employers who have employees in Massachusetts should be aware of the 2022 MCC limits.

Deductible Limits 2021 2022
Employee-only tier deductible $2,700 $2,750
Employee-only tier separate Rx deductible $300 $340
Family tier deductible $5,400 $5,500
Family tier Rx deductible $660 $680

 

Maximum Out-of-Pocket (OOP) Limits 2021 2022
Employee-only tier OOP max $8,550 $8,700
Family tier OOP max  $17,100 $17,400

 

Bulletin 06-21. The MCC Regulations for Calendar Year 2022 »
Bulletin 05-20. The MCC Regulations for Calendar Year 2021 »
Mass.gov. Health Care: Frequently Asked Questions for Employers, Form MA 1099-HC »


December 07, 2021

MA PFML 2022 Poster and Notices Updated

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The Department of Medical and Family Leave recently updated the PFML workplace poster, employer notice, and rate sheet to reflect the 2022 rates in several languages.

For 2022, employers are not required to reissue these notices to existing employees. Employers are required to distribute these updated notices to new employees who start their employment on or after January 1, 2022.

As a reminder, effective January 1, 2022, the new contribution rate on eligible employee wages will be 0.68% of each Massachusetts employees' eligible wages. The covered employers are encouraged to communicate regarding the 2022 MA PFML contribution amount with their payroll vendors to ensure that the appropriate amounts will be withheld through payroll.

Affected employers should be aware of these developments.

2022 PFML Workplace Poster »
2022 Employer Notice for a Workforce with 25 or More Covered Individuals »
2022 Employer Notice for a Workforce with Fewer than 25 Covered Individuals »


December 07, 2021

Reminder: MA HIRD Form Due December 15, 2021

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The Health Insurance Responsibility Disclosure (HIRD) form is a state reporting requirement in Massachusetts that applies to in-state and out-of-state employers with employees in Massachusetts. The HIRD form collects employer-level information about an employer's sponsored insurance (ESI) offerings, i.e., their group health plan(s). The HIRD form must be completed and submitted online by December 15, 2021, for the current reporting year.

To file a HIRD form, employers must log in to their MassTaxConnect account and select the 'File health insurance responsibility disclosure' hyperlink under the account alerts.

MA HIRD Form FAQs and Instructions »


November 09, 2021

Health Connector Open Enrollment Period Announced

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On October 15, 2021, the Division of Insurance released Bulletin 2021-14, announcing that the Massachusetts Health Connector (the state-based marketplace) open enrollment period is from November 1, 2021, through January 23, 2022, for health insurance that will become effective beginning January 1, 2022.

Although this change affects individuals who will go to the marketplace, employers should be mindful of the Health Connector's open enrollment period. Employees going to the marketplace may have to experience a qualifying event that would allow them to terminate their coverage under the employer's plan.

Bulletin 2021-14 »
Massachusetts Health Connector Open Enrollment site »


November 09, 2021

MA PFML 2022 Premium Rate and Maximum Benefit Amount Announced

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The Department of Medical and Family Leave recently announced that the 2022 MA PFML premium contribution is 0.68% of an employee's eligible wages, which is a decrease from the 2021 premium rate of 0.75%. The allocation of employer and employee contributions is determined based on the number of employees who work for the employer in Massachusetts. For employers with 25 or more employees in Massachusetts, the employees' contribution share is 0.344%, and the employer contribution share is 0.336% of the total 0.68% premium. For employers with fewer than 25 employees in Massachusetts, the employees' contribution share is 0.344% of the total 0.68% premium, and there is no required employer contribution.

The maximum benefit payment an eligible employee can receive in 2022 is $1,084.31/ week - an increase from the 2021 maximum of $850/week.

Employers with employees in Massachusetts should be mindful of these changes to the PFML program.

MA PMFL Fact Sheet »
MA PFML Contribution Rates for Employers »


September 14, 2021

Continued Access to Telehealth Services in 2021

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On September 7, 2021, Commissioner Anderson released Bulletin 2021-10, supplementing and superseding the provisions of Bulletin 2020-04 ('Managed Care Practices and Continued Access to Telehealth Services'). The bulletin outlines the Division of Insurance's expectations regarding continued access to telehealth services.

Considering the ongoing impacts of the COVID-19 virus, carriers are expected to provide clear communication materials to in-network providers to explain how to submit claims for reimbursement of telehealth benefits. As was noted in Bulletin 2020-04, carriers may also reimburse providers for services delivered via telehealth at the rate of reimbursement defined by Chapter 260. Carriers who wish to alter telehealth rates must file implementation plans with the division. The division also expects carriers to develop comprehensive disclosure materials for consumers, to be communicated in the fall of 2021.

This guidance is for insurance carriers, but plan sponsors should familiarize themselves with this guidance on telehealth services.

Bulletin 2021-10 »


September 14, 2021

COVID Guidance Following End of State of Emergency

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On August 31, 2021, Commissioner Anderson issued Bulletin 2021-08. The bulletin provides guidance to insurers on COVID-19 testing, treatment and vaccines. The state of emergency issued by Gov. Baker on March 10, 2020, ended as of June 15, 2021. However, on May 28, 2021 the state issued a declaration of a public health emergency due to the continuing threat of COVID-19. This bulletin clarifies the Division of Insurance's expectations of insurance carriers since the risk of COVID-19 has not been eliminated.

The bulletin indicates that carriers must continue to cover COVID-19 testing without cost-sharing or utilization management for symptomatic individuals, people identified as close contacts of someone with COVID-19, and asymptomatic individuals as long as the individual qualifies under criteria established by the state's Secretary of Health and Human Services, the Department of Public Health or the federal government. Specifically, polymerase chain reaction (PCR) tests and antigen tests must be covered.

The bulletin also reminds carriers that they are expected to provide coverage for all emergency, inpatient services, outpatient services and cognitive rehabilitation services related to COVID-19 without the use of a prior authorization process. Additionally, carriers should cover all claims where COVID-19 is listed as a diagnosis without cost-sharing.

Carriers are also expected to provide coverage for all COVID-19 vaccines without cost-sharing or utilization management. While carriers are expected to cover services that may be related to reactions to the COVID-19 vaccine, they can apply cost-sharing since those services are not considered related to the treatment of COVID-19.

The division also expects carriers that are acting as administrators for employer-sponsored self-insured plans to take steps that are consistent with the bulletin's provisions. Both employers of fully insured and self-insured health plans should be aware of this guidance.

Bulletin 2021-08 »


September 14, 2021

HIV PrEP Coverage

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On September 7, 2021, Commissioner Anderson released Bulletin 2021-09, indicating that that the Division of Insurance expects carriers to comply with federal guidance requiring coverage of HIV pre-exposure prophylaxis (PreP) as a preventive health service. On July 19, 2021, the US Preventive Services Task Force issued guidance indicating that HIV PrEP must be offered without cost-sharing as a preventive service.

The division expects that carriers will come into compliance with the federal requirement to offer this drug without cost-sharing by no later than 60 days from the date of the July 19, 2021, US Preventative Services Task Force guidance. Employers should be aware of this requirement.

Bulletin 2021-09 »


September 14, 2021

Prohibited Discrimination on the Basis of Gender Identity or Gender Dysphoria

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On September 9, 2021, Commissioner Anderson released Bulletin 2021-11 to clarify the continuing applicability of Massachusetts law prohibiting discrimination on the basis of gender identity or gender dysphoria. The bulletin clarifies discriminatory practices prohibited in Massachusetts in light of changes to state law since the last bulletin addressed this subject (Bulletin 2014-03).

In 2018, Massachusetts amended its public accommodations law to include gender identity as a protected class and, in 2020, the state added specific discrimination protections regarding disability insurance. The Massachusetts Commission Against Discrimination also released guidance affirming that places of public accommodation include businesses that provide services, such as insurance companies.

In keeping with these amendments, the division uses this bulletin to remind carriers that they may not deny or categorically exclude medically necessary treatment based on an individual's gender identity or gender dysphoria. In determining their obligations, carriers are expected to consult the most up-to-date medical standards set forth by nationally recognized medical experts in the transgender health field. Additionally, carriers must not single out a treatment or procedure for exclusion of coverage because it is associated with transgender people or gender dysphoria. They also may not impose stricter requirements for coverage for a service when used to treat or ameliorate symptoms of gender dysphoria than when used to treat other conditions. Carriers must also comply with applicable mental health requirements.

The division also expects carriers that are acting as administrators for employer-sponsored self-insured plans to take steps that are consistent with the bulletin's provisions. Both employers of fully insured and self-insured health plans should be aware of this guidance.

Bulletin 2021-11 »


June 08, 2021

COVID-19 Emergency Paid Sick Leave Mandated

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On May 28, 2021, Gov. Baker signed House No. 3702 into law, mandating COVID-19 emergency paid sick leave for Massachusetts residents. From May 28, 2021, through September 30, 2021, employees can take up to 40 hours of COVID-19 Massachusetts emergency paid sick leave (MA EPSL). All employers, except for the federal government, must provide MA EPSL, and the law establishes a state fund that will be used to reimburse employers for the leave they provide.

Under MA EPSL, employers are required to offer up to 40 hours of EPSL to Massachusetts employees who usually work 40 hours per week. Employees working part-time hours would be entitled to the number of hours they would normally work in a 14-day span. Employees may take MA EPSL if they are absent from work due to:

  • The employee's need to self-isolate and care for themselves due to a COVID-19 diagnosis.
  • The employee's need to care for a family member who is self-isolating due to a COVID-19 diagnosis or needs diagnosis, care or treatment for COVID-19 symptoms.
  • A quarantine order or other determination by a local, state or federal public official, a health authority, or the employee's employer that the employee's presence at work would jeopardize the health of others because of the employee's potential symptoms of or exposure to COVID-19.
  • The employee's need to care for a family member who has received one of the above orders or determinations.
  • The employee's inability to telework because of a COVID-19 diagnosis with inhibiting symptoms.

For these purposes, a family member includes the spouse, domestic partner, child, parent or parent of a spouse or domestic partner of the employee. An employee may also take leave to care for a person who stood in loco parentis to the employee when such employee was a minor child or a grandchild, grandparent or sibling of the employee, but only if the employee has a personal relationship with the person.

Importantly, MA EPSL must be provided in addition to any other job-protected leave, including leaves provided pursuant to the Massachusetts Earned Sick Time Law, collective bargaining agreements, federal law or the employers existing leave policies. The maximum compensation for MA EPSL is up to $850 per week, and that amount would be reduced if the amount an employee would receive due to other forms of paid time off (plus the MA EPSL) exceeds their normal pay.

The newly established COVID-19 EPSL Fund will reimburse eligible employers for providing employees with the COVID-19 EPSL. In order to claim the reimbursement, the employer should request that employees requesting the leave provide the employer a written request for COVID-19 EPSL which includes the following:

  • The employee's name.
  • The dates for which leave is requested and taken.
  • A statement of the reason the employee is requesting leave and written support for it.
  • A statement that the employee is unable to work, including by telework.
  • If the reason for leave is based on a quarantine order or self-quarantine recommendation, the employee should include the name of the governmental entity or healthcare provider that ordered the quarantine. If the employee is taking care of a family member that is quarantining, the employee should include the name of the family member.

Massachusetts will soon provide a notice regarding MA EPSL, and employers are required to distribute that to all employees. The state also intends to provide additional guidance on the law as employers implement it.

Given that the law became effective on May 28, 2021, employers with Massachusetts employees should immediately familiarize themselves with this bill and provide EPSL in accordance with the requirement.

H. No. 3702 »


May 25, 2021

Consumer's Guide to Medicare

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On April 26, 2021, Commissioner of Insurance Anderson released Bulletin 2021-05, which includes a publication entitled “A Massachusetts Consumer’s Guide to Medicare.” The guide is meant to be provided alongside the annual federal publication, “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.”

The publication covers the basics on applying for Medicare and is designed to educate individuals on the provisions of Medicare. While this resource does not impact employer plan sponsors, they may want to make it available to employees who may have questions concerning Medicare.

Bulletin 2021-05 »


May 25, 2021

Required Coverage for PANDAS and PANS

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On April 27, 2021, Commissioner of Insurance Anderson issued Bulletin 2021-06, informing insurers of the requirement to cover treatment for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS).

The division expects insurers to notify network providers and covered members of the mandated coverage, to update their administrative processes to enable members to access treatment for PANDAS and PANS, and to identify providers within their networks who can provide PANDAS and PANS services.

This insurance mandate will apply to insured health benefits that are issued or renewed on or after January 1, 2022. Although this mandate applies to insurers, employers should familiarize themselves with it in the event that a participant has questions about this coverage.

Bulleting 2021-06 »


April 27, 2021

Mini-COBRA Premium Assistance

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On April 16, 2021, the Division of Insurance announced the premium assistance available to individuals under the American Rescue Plan Act of 2021 (ARPA). Massachusetts' announcement reiterated that the ARPA provides premium assistance to individuals on federal COBRA and Massachusetts 'mini-COBRA.' The assistance is available for April 1, 2021, through September 30, 2021, and eligible individuals should receive a notice from their employer.

The notice also mentions that Massachusetts residents will have a special enrollment period to enroll on the Massachusetts exchange (Health Connector) when their federal COBRA subsidy expires after September.

Massachusetts employers should comply with ARPA, as applicable.

Mini-COBRA Premium Assistance for Eligible Massachusetts Residents »


April 27, 2021

Updated Guidance on COVID-19 Treatment

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On April 2, 2021, Commissioner Anderson released Bulletin 2021-03, supplementing and superseding Bulletins 2020-10 (Credentialing and Prior Authorization during COVID-19) and Bulletin 2020-13 (Coverage for COVID-19 Treatment and Out-of-Network Emergency and Inpatient Reimbursement During the COVID-19 Health Crises).

The bulletin reminds carriers that they are expected to provide coverage and forgo any cost sharing for medically necessary outpatient COVID-19 treatment and rehabilitation services delivered by in-network providers. When the services are provided in an emergency department, there also should not be any cost sharing whether in-network or out-of-network. Additionally, all in-network providers must be reimbursed at that contractually allowed amounts.

The Division also expects carriers to suspend any prior authorization requirements and to provide inpatient hospitals with up-to-date lists of in-network rehabilitation hospitals and skilled nursing facilities. The bulletin also explains how carriers are expected to reimburse out-of-network acute care hospitals and the out-of-network providers providing emergency department and inpatient services.

Although this guidance affects insurance carriers, employers should familiarize themselves with this guidance.

Bulletin 2021-03 »


April 27, 2021

Updated Guidance on Telehealth Services

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On April 9, 2021, Commissioner Anderson released Bulletin 2021-04, supplementing and superseding Bulletin 2020-04 (Emergency Measures to Address and Stop the Spread of COVID-19). Chapter 260 of the Acts of 2020 was passed after that, and requires coverage for telehealth services within insured health plans issued or renewed in the state.

Until the Division of Insurance promulgates rules regarding telehealth services, providers should comply with Bulletin 2020-04's requirements. One notable exception is that Chapter 260 allows carriers to undertake utilization review, including preauthorization to determine the appropriateness of telehealth as a means of delivering healthcare services, if the determination is made in the same manner as if the services were delivered in person. However, the division expects carriers not to make changes until they provide the division with an implementation plan.

Carriers are also expected to provide clear communication materials to in-network providers to explain how to submit reimbursement claims for telehealth services. Additionally, they must reimburse providers for services delivered via telehealth at a rate that is no less than the reimbursement required under Chapter 260.

Although this guidance affects insurance carriers, employers should be aware of these mandates.

Bulletin 2021-04 »


February 17, 2021

COVID-19 Exchange Special Enrollment Period

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On February 3, 2021, Commissioner Anderson released Bulletin 2021-02, providing a special enrollment period (SEP) on the state exchange as a part of the state’s ongoing response to the COVID-19 pandemic. The SEP is in effect from February 3, 2021, through May 23, 2021. As background, individuals may usually only elect coverage through the state exchange during open enrollment or special enrollment periods.

Although this change affects the individual market, employers should keep this in mind as it would likely create a qualifying event that would allow for an employee to potentially drop employer coverage (for themselves or their dependents) to go on the Massachusetts exchange.

Bulletin 2021-02 »


February 02, 2021

Additional Guidance Addressing COVID-19 Vaccines

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On January 21, 2021, Commissioner Anderson issued Bulletin 2021-01, providing updated guidance reminding carriers that they should facilitate members' access to COVID-19. This bulletin adds additional carrier expectations to those that were expressed in Bulletin 2020-32 (which was discussed in the January 5, 2021, edition of Compliance Corner).

This bulletin clarifies that the Division of Insurance expects carriers to:

  • Forgo any cost sharing for vaccinations at providers' offices (including from out-of-network providers
  • Reimburse providers (whether in-network or out-of-network) for the cost of administering COVID-19 vaccines at a level that is higher than the MassHealth rate of reimbursement
  • Reimburse providers for the vaccine separately if it is administered and billed separately from the full office or emergency visit
  • Pay all subrogation claims for any vaccines administered at pop-up locations, mass vaccination sites, or public clinics hosted by state or municipal health departments

The division also encourages carriers that are acting as administrators to self-insured plans to follow this guidance as well.

Although this bulletin is directed towards insurance carriers, employers based in Massachusetts should familiarize themselves with this guidance as they continue to contend with participants being affected by COVID-19.

Bulletin 2021-01 »


January 05, 2021

Addressing COVID-19 Vaccines

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On December 29, 2020, Commissioner Anderson issued Bulletin 2020-32, reminding carriers that they should facilitate members' access to COVID-19 vaccines. The division intends for members to have access to the vaccine through insurance, and for the cost of obtaining the vaccine not to be a barrier.

Carriers are expected to communicate all vaccine options to covered persons. Additionally, carriers are expected to:

  • Provide descriptive vaccine information on plan websites
  • Maintain dedicated help lines to respond to calls about the new coronavirus and provide information on vaccine providers
  • Relax prior approval requirements for the vaccine (including for out-of-network providers)
  • Reimburse all providers for the cost of administering COVID-19 vaccines and forego any cost sharing for the individual

Although this guidance is directed towards insurance carriers, employers based in Massachusetts should familiarize themselves with this guidance as they continue to contend with participants being affected by COVID-19.

Bulletin 2020-32 »


January 05, 2021

Continuation of Flexibility in Efforts to Treat and Restrict the Spread of COVID-19

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On December 29, 2020, Commissioner Anderson issued Bulleting 2020-31, extending the protections offered in several bulletins addressing the COVID-19 crisis. Specifically, this bulletin reminds insurance carriers that the state of emergency continues that they should take special care to ensure that they are still operating in a manner that is consistent with these bulletins:

  • Bulletin 2020-02 - Addressing COVID-19 (Coronavirus) Testing and Treatment
  • Bulletin 2020-04 - Emergency Measures to Address and Stop the Spread of COVID-19 (Coronavirus)
  • Bulletin 2020-06 - Administration of Prescription Drug Benefits During COVID-19 (Coronavirus) Public Health Crisis
  • Bulletin 2020-07 - Making Consumer Information Available During the COVID-19 Crisis
  • Bulletin 2020-10 - Credentialing and Prior Authorization During COVID-19 Health Crisis
  • Bulletin 2020-13 - Coverage for COVID-19 Treatment and Out-of-Network Emergency and Inpatient Reimbursement During the COVID-19 Health Crisis
  • Bulletin 2020-15 - Relaxing Certain Health Plan Administrative Procedures During the COVID-19 Health Emergency
  • Bulletin 2020-16 - COVID-19 (Coronavirus) Testing
  • Bulletin 2020-21 - Continued Relaxation of Prior Authorization in Response to the COVID-19 Health Emergency
  • Bulletin 2020-23 - Updated Guidance for COVID-19 PCR and Antigen Testing
  • Bulletin 2020-25 - Easing Administrative Billing for PCR and Antigen Testing
  • Bulletin 2020-28 - Continued Relaxation of Certain Administrative Procedures in Response to the COVID-19 Health Emergency

The division also clarified that they now intend for carriers to ease administrative processes (as outlined in Bulletin 2020-21) through at least March 31, 2021, in order to allow hospitals to devote their resources to treatment of COVID-19 patients.

Although this guidance is directed towards insurance carriers, employers based in Massachusetts should familiarize themselves with this guidance as they continue to contend with participants being affected by COVID-19.

Bulletin 2020-31 »


January 05, 2021

Continuation of Flexibility in the Issuance and Administration of Insurance

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On December 29, 2020, Commissioner Anderson issued Bulletin 2020-30, extending the protections offered in Bulletin 2020-05. Bulletin 2020-30 reiterates that the Division of Insurance expects insurance carriers to continue to take steps to help address concerns about maintaining coverage and preserving the insurance market during the COVID-19 crisis. The division requests that carriers communicate and allow flexibility as it pertains to payment of premiums and continuation of coverage. Specifically, carriers should explain grace periods that are available, work with employers and individuals experiencing financial hardships, and explore ways to relax due dates for premiums.

In addition to the requests made in Bulletin 2020-05, the division now also expects carriers to maintain customer support services to provide consumer information about their insurance options in a way that will allow them to prevent a loss of coverage.

Although this guidance is directed towards insurance carriers, employers based in Massachusetts should familiarize themselves with this guidance as they continue to contend with participants being affected by COVID-19.

Bulletin 2020-30 »


January 05, 2021

Eligible Workers May Begin Requesting Paid Family and Medical Leave

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As of January 1, 2021, workers can request benefits under the Paid Family and Medical Leave Law (PFML, as enacted in 2018). (See the August 18, 2020, editions of Compliance Corner for discussions of the PFML and the finalized rules.)

Beginning in January, workers can begin to apply for leave to welcome a new child into their family, for their own serious health condition and for certain military considerations. In July 2021, workers will be able to apply for leave to care for an ill relative.

Employers should be aware that workers may begin to request this leave. For more information about the law, ask your advisor for a copy of our white paper on Massachusetts PFML.

Press Release on the Launch of PFML Benefit


December 08, 2020

Information Regarding the Renewal of Fully-Insured PFML Exemptions

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On October 29, 2020, the Department of Family and Medical Leave provided information concerning the renewal of employers' paid family and medical leave (PFML) fully-insured exemptions. As background, employers that provide a private leave plan can apply for an exemption under the PFML. When employers last received this exemption, it was set to expire on December 31, 2020. They were also notified that if they did not have the private insurance in place on January 1, 2021, they would need to pay PFML contributions going back to October 1, 2019.

Employers that will file for an exemption for 2021 have from November 30, 2020, through December 31, 2020 to apply. The guidance provides links to detailed directions on filing and provides instructions on how the form must be completed. Employers that do not intend to renew their exemption will need to contact the PFML Contact Center at (617) 466-3950.

Information Regarding the Renewal of Your Fully-Insured PFML Exemption »


September 29, 2020

Extension of Relaxation of Prior Authorization Procedures for COVID-19

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On September 22, 2020, Commissioner Anderson released Bulletin 2020-28, extending the guidance from Bulletin 2020-21 through December 31, 2020. As background, Bulletin 2020-21 required insurance carriers to provide flexibility because of the COVID-19 public health crisis.

As a reminder, the guidance requires carriers to:

  • Forego prior authorization reviews or concurrent reviews for any scheduled surgeries and behavioral health or non-behavioral health admissions at acute care and mental health hospitals for a period lasting through September 30.
  • Devote carrier resources to assist hospitals with discharge planning.
  • Provide hospitals additional time to respond to carrier requests for claims review information or to process internal and external appeals and document claims.
  • Delay audits of hospital payments.
  • Process all clean claims according to prompt payment standards.
  • Explore ways to streamline coding and billing policies to reduce the administrative complexity of coding for claims.
  • Develop process that expedites health plan credentialing.

Additionally, the guidance indicates that it would not be appropriate for carriers to require prior authorization of COVID-19 treatment or to conduct retrospective reviews to deny emergency or inpatient hospital services for COVID-19 treatment.

This requirement falls on insurers, but employers should also familiarize themselves with this guidance in case any employees ask about it.

Bulletin 2020-28 »


September 29, 2020

Massachusetts Exchange Special Open Enrollment

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On September 14, 2020, Commissioner Anderson released Bulletin 2020-27, which announces a special open enrollment period on the Commonwealth Health Insurance Connector Authority (the 'Connector'). As background, states with their own exchange can implement special enrollment periods that lengthen the standard annual exchange period. The Connector has chosen to do so this year, providing that the open enrollment period will begin November 1, 2020, and end on January 23, 2021.

While this change will affect individuals that will enroll on the Connector, employers should be mindful of this extension in case there are employees who seek to drop coverage under their plans to take advantage of the Connector's special open enrollment period.

Bulletin 2020-27 »


September 01, 2020

Time Extension Granted for PFML Private Plan Exemption

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On August 12, 2020, the Massachusetts Department of Family and Medical Leave (DFML) published new guidance relating to an extension for PFML private plan exemptions. According to the guidance, for employers that currently have an exemption from remitting contributions to the Family and Employment Security Trust Fund for the period beginning October 1, 2019, and ending September 30, 2020, DFML is extending the private plan exemption until December 31, 2020. The guidance also states that renewal applications will not be accepted before November 30, 2020. On November 30, 2020, the renewal application period will open for employers with fully insured private plans. Employers must renew their PFML exemption in MassTaxConnect by providing DFML with the policy form number via an Insurance Declaration Document signed by the carrier on or before December 31, 2020. This number will be located on the PFML policy forms that will be provided to the employer by their PFML insurance carrier. Lastly, employers that intend to renew and switch to a self-insured plan may do so beginning on October 1, 2020, by logging on to the employer's PFML account in MassTaxConnect to complete the renewal application.

Massachusetts employers interested in the exemptions should review the new guidance and work with their carriers in renewing their applications.

PFML Guidance »


August 18, 2020

Final Regulations on Paid Family Medical Leave Released

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On July 24, 2020, the Department of Family and Medical Leave released the final regulations for the Paid Family and Medical Leave Law (PFML). As background, Massachusetts employers must provide paid family and medical leave beginning in January 2021. The leave is funded through a payroll tax.

The final regulations make a number of changes to the proposed rules. Some of the major revisions are as follows:

  • Employers that are seeking an exemption due to providing a private plan must provide leave to all employees, covered workers and former employees in order for their private plan to be exempted.
  • Covered individuals must provide notice to their employer before they apply for PFML benefits, otherwise, their application can be rejected.
  • Covered individuals must submit their application at least 30 days, but no more than 60 days, in advance of the leave unless they are reasonably unable to do so.
  • Covered individuals with multiple employers will have their weekly benefit amount calculated based on wages for a specific employer, but they are not required to take leave from each employer at the same time.
  • Substance use disorders can qualify as a serious health condition that would allow the use of PFML for treatment of the condition.
  • Intermittent leave can be taken in 15-minute increments, but payment of PFML benefits will not be paid out in requests of less than eight hours.
  • The wages or wage replacement benefits that will reduce PFMLA have been adjusted to include benefits received through an approved, exempted private plan or any wages that are received from another employer or self-employment.
  • There will be an initial seven-day waiting period for every application for benefits, with the exception of PFML for pregnancy or recovery from childbirth. Also, no more than 12 weeks of leave benefits are permitted in a year, even if there are multiple births.
  • The final rules also make changes to many of the definitions in the law.

Employers should review the final regulations as they will impact employers’ compliance with the PFML, which employees will be able to take as of January 1, 2021.

PFML Final Regulations


August 18, 2020

Carriers Must Cover Certain Contraceptives Without Cost Sharing

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On August 7, 2020, the Division of Insurance issued Bulletin 2020-26, requiring insurance carriers to provide contraceptives without cost sharing. As background, the ACA’s preventive care mandate was interpreted to require coverage of contraceptives. Massachusetts followed suit and incorporated the requirement to offer contraceptives in Massachusetts law through Chapter 120 of the Acts of 2017. This bulletin updates Massachusetts’ guidance on this requirement.

Specifically, the bulletin discusses the different FDA-approved contraceptive methods and clarifies that carriers can choose to cover more than one product of each method (and could even charge for additional products) as long as at least one version is provided without cost sharing. Carriers must also provide a specific contraceptive without cost sharing if an individual’s physician recommends that particular product based on a medical determination. Additionally, coverage for voluntary female sterilization procedures and FDA-approved emergency contraception must be allowed without a prescription. The bulletin goes on to require that carriers provide coverage for patient education and counseling on contraception and follow-up services related to the contraception.

The bulletin exempts churches or qualified church-controlled organizations from its requirements provided that the church gives employees a written notice stating that they will not offer contraceptives or certain methods for religious reasons, and defines such an organization.

The bulletin and Chapter 120 are already effective and insurers must ensure continuing compliance. Employers should be aware of this guidance.

Bulletin 2020-26 »


July 21, 2020

Updated Guidance on COVID-19 Testing

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On July 8, 2020, the Division of Insurance issued Bulletin 2020-23, updating Bulletins 2020-02 and 2020-16 to communicate that they expect insurance carriers to cover polymerase chain reaction (PCR) and antigen testing of COVID-19 for symptomatic individuals, those that are in close contact with someone who has been diagnosed with COVID-19, and any asymptomatic individual that is admitted to a Massachusetts healthcare facility.

Additionally, the division expects carriers to:

  • Establish network arrangements with dedicated “pop-up” locations and drive-through testing sites so that PCR and antigen tests are available in-network
  • Ensure access to COVID-19 at-home testing, when the test is ordered by a provider
  • Eliminate prior approval requirements for PCR and antigen test when medically appropriate
  • Relax out-of-network requirements and procedures for access to testing or urgent treatment
  • Forgo any cost sharing for COVID-19 testing, counseling and vaccinations

The guidance also indicates that the division encourages carriers that serve as plan administrators of self-funded plans to comply with these guidelines.

These requirements fall on insurers, but employers should also familiarize themselves with this guidance in case any employees ask about it.

Bulletin 2020-23 »


July 07, 2020

Continued Relaxation of Prior Authorization Procedures for COVID-19

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On June 25, 2020, the Division of Insurance issued Bulletin 2020-21, requiring insurance carriers to continue to provide flexibility because of the COVID-19 public health crisis. Specifically, the bulletin requires carriers to continue to:

  • Forego prior authorization reviews or concurrent reviews for any scheduled surgeries and behavioral health or nonbehavioral health admissions at acute care and mental health hospitals for a period lasting through September 30
  • Devote carrier resources to assist hospitals with discharge planning
  • Provide hospitals additional time to respond to carrier request for claims review information or to process internal and external appeals and document claims
  • Delay audits of hospital payments
  • Process all clean claims according to prompt payment standards
  • Explore ways to streamline coding and billing policies to reduce the administrative complexity of coding for claims
  • Develop a process that expedites health plan credentialing

Additionally, the guidance indicates that it would not be appropriate for carriers to require prior authorization of COVID-19 treatment or to conduct retrospective reviews to deny emergency or inpatient hospital services for COVID-19 treatment.

This requirement falls on insurers, but employers should also familiarize themselves with this guidance in case any employees ask about it.

Bulletin 2020-21 »


June 23, 2020

Flexibility with Early Intervention Services Due to COVID-19

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On June 8, 2020, the Division of Insurance issued Bulletin 2020-19, requiring insurers to provide more time for early intervention services because of the COVID-19 crisis. As background, Massachusetts special education statutes require insurers to provide early intervention services for children up to age three. These services are considered medically necessary and allow the education system to develop individualized educational programs for any children with special educational needs.

Considering COVID-19, this bulletin requires insurers to extend coverage for early intervention services to certain children who turned three between March 15, 2020, and August 31, 2020. The extension should continue until the services have been provided to the children or until October 15, 2020, whichever occurs sooner.

This requirement falls on insurers, but employers should also familiarize themselves with this guidance in case any parents ask about it.

Bulletin 2020-19 »


May 27, 2020

COVID-19 Testing Guidance Updated

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On May 18, 2020, Commissioner Anderson released Bulletin 2020-16, which updates the Division of Insurance's guidance on COVID-19 testing. The bulletin updates Bulletin 2020-02, and reiterates the division's expectations of insurance carriers. Specifically, the division expects carriers to:

  • Establish dedicated help lines to respond to calls about COVID-19.
  • Relax prior approval requirements and procedures.
  • Eliminate prior approval requirements for antigen and polymerase chain reaction (PCR) testing for COVID-19.
  • Relax out-of-network requirements and procedures when access to testing or urgent treatment is unavailable in-network.
  • Forego any cost sharing for medically necessary COVID-19 testing, counseling and vaccinations when in-network coverage is unavailable.
  • Cover PCR or antigen tests designed to detect the presence of the novel coronavirus when a covered patient has any symptoms or has been exposed to COVID-19.
  • Cover antibody tests when such tests are being conducted consistent with Department of Public Health and CDC guidance.

This guidance does not provide any compliance obligations for employers, but they should familiarize themselves with the directive.

Bulletin 2020-16 »


May 27, 2020

Exchange Special Enrollment Period Extended

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On May 21, 2020, Commissioner Anderson released Bulletin 2020-18, extending the special enrollment period on the Commonwealth Health Insurance Connector. Now, uninsured Massachusetts residents can enroll in coverage on the Connector through June 23, 2020.

Employers with employees in Massachusetts should be aware of this option should employees need to enroll in a plan on the exchange due to the termination of their employment or eligibility under the employer's plan.

Bulletin 2020-18 »


April 28, 2020

FAQs During COVID-19 Public Health Crisis

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On April 9, 2020, the Division of Insurance released a set of frequently asked questions (FAQs) concerning the COVID-19 health crisis. Although the FAQs are meant to be consumer-facing, they answer a number of questions concerning business decisions and their impact on employer-sponsored health insurance, as well as questions concerning the impact of furloughs on participants' health coverage. For example, the FAQs address what employees can do if they are furloughed or laid off and need to keep their health coverage. They also remind individuals of the special enrollment period for the exchange.

Additionally, the FAQs answer questions concerning coverage for testing and treatment of COVID-19, confirming that there should be no out-of-pocket costs associated with COVID-19 testing or treatment. The FAQs also discuss how participants can go about obtaining needed prescriptions and non-COVID-19 treatment for health conditions.

The FAQs don't necessarily provide any novel information. However, the document serves as a sort of one-stop resource that summarizes and references everything that the Division of Insurance has done thus far. Employers can review the FAQs if they have any COVID-19-related insurance questions.

Frequently Asked Questions During COVID-19 (Coronavirus) Public Health Crisis »


April 28, 2020

Updated Guidance on COVID-19 Treatment Requirements

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On April 9, 2020, Commissioner Anderson released Bulletin 2020-13, which supplements prior bulletins concerning the appropriate coverage of treatment for COVID-19. Specifically, the bulletin modifies Bulletins 2020-02 and 2020-04, by communicating how insurers are expected to cover COVID-19 testing and treatment on an in- and out- of network basis. It also communicates that the Division of Insurance expects that insurers will allow for treatment at acute care hospitals.

Additionally, out-of-network emergency and inpatient treatment should be paid at the provider's contracted rate, or if there is no contract between the hospital and the insurer, services should be paid at a rate equal to 135% of the rate paid by Medicare for those services. The bulletin also indicates that they expect insurers acting as TPAs for self-funded plans to encourage plan sponsors to meet these same guidelines.

While this bulletin doesn't impose any additional obligations on employers, they should familiarize themselves with this guidance.

Bulletin 2020-13 »


April 28, 2020

Exchange Special Enrollment Period Extended

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On March 30, 2020, Commissioner Anderson released Bulletin 2020-09, extending the special enrollment period on the Commonwealth Health Insurance Connector. Now, uninsured Massachusetts residents can enroll in coverage on the Connector through May 25, 2020, which is a month longer than the original special enrollment period that was granted through Bulletin 2020-03.

Employers with employees in Massachusetts should be aware of this option should employees need to enroll in a plan on the exchange due to the termination of their employment or eligibility under the employer's plan.

Bulletin 2020-09 »


April 14, 2020

Fair Labor Division FAQs on COVID-19

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On April 10, 2020, the Attorney General's Fair Labor Division (FLD) provided a set of frequently asked questions about employee rights and employer obligations related to COVID-19. While a majority of the questions address employment and labor law concerns, a couple of questions focused on leave provided by the Massachusetts earned sick time law and how it differs from the leave provided by the FFCRA.

Specifically, FAQ eight indicates that earned sick time can be used if a public health official or health care provider requires an employee or family member to quarantine or if the public health official or health care provider recommend such a quarantine and the employee follows their recommendation. The FAQ encourages, but does not require, that earned sick time be allowed if an employee misses work because their child's school is closed due to a stay-at-home or shelter-in-place order from a state or local authority. However, it does remind employers that FFCRA leave would be required for that situation.

Additionally, FAQs 12-14 address the FFCRA and link to the DOL's guidance on the law. FAQ 13 clarifies that if employees are eligible for both FFCRA leave and Massachusetts earned sick leave, they may choose to take FFCRA leave first and to save the Massachusetts earned sick leave for later use.

Employers should familiarize themselves with this guidance in order to ensure that they are meeting the different employment obligations.

Frequently Asked Questions About COVID-19: Employee Rights and Employer Obligations »


March 31, 2020

Massachusetts COVID-19-Related Guidance

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The Division of Insurance issued a number of bulletins addressing the COVID-19 crisis. Those bulletins are summarized here:

  • Special Enrollment Period for Exchange: On March 12, 2020, Commissioner Anderson released Bulletin 2020-03, announcing a special enrollment period on the Commonwealth Health Insurance Connector. Currently uninsured Massachusetts residents can enroll in coverage on the Connector through April 25, 2020. Employers with employees in Massachusetts should be aware of this option should employees need to enroll in a plan on the exchange due to the termination of their employment or eligibility under the employer's plan.
  • Emergency Measures to Address and Stop the Spread of COVID-19: On March 16, 2020, Commissioner Anderson released Bulletin 2020-04, intending to expand the use of telehealth to treat medically necessary health conditions in order to impede the transmission of the coronavirus. The bulletin modifies Bulletin 2020-02 by requiring carriers to forego any prior authorization requirements or cost sharing for COVID-19 treatment via telehealth. The bulletin also requires carriers to cover telehealth services as if the service is provided on an in-person basis.
  • Flexibility in the Issuance and Administration of Insurance: On March 23, 2020, Commissioner Anderson released Bulletin 2020-05, directing carriers to take steps to help address concerns about maintaining coverage and preserving the insurance market during the COVID-19 crisis. The Commissioner requests that carriers communicate and allow flexibility as it pertains to payment of premiums and continuation of coverage. Specifically, carriers should explain grace periods that are available, work with employers and individuals experiencing financial hardships, and explore ways to relax due dates for premiums.
  • Administration of Prescription Drug Benefits During COVID-19 Crisis: On March 26, 2020, Commissioner Anderson released Bulletin 2020-06, requesting that carriers take steps to help address concerns about prescriptions. Carriers are expected to work with pharmacies to limit the spread of the coronavirus by being flexible with signature requirements and allowing for mailed prescriptions and early refills, where appropriate. The bulletin also expects carriers to establish prior authorization systems to prevent the hoarding of chloroquine and hydroxychloroquine.
  • Making Consumer Information Available During COVID-19 Crisis: On March 26, 2020, Commissioner Anderson released Bulletin 2020-07, notifying carriers that they should make appropriate information available via consumer phone lines and their websites. Specifically, they should be prepared to provide resources that describe coverage benefits and to ensure that providers and vendors are aware of the benefits and services that are available to address COVID-19.

Much of this guidance is directed towards insurance carriers. However, employers based in Massachusetts should familiarize themselves with this guidance as they contend with participants being affected by COVID-19.

Bulletin 2020-03 »
Bulletin 2020-04 »
Bulletin 2020-05 »
Bulletin 2020-06 »
Bulletin 2020-07 »


March 17, 2020

Coronavirus Testing and Treatment to Be Provided Without Cost Sharing

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On March 6, 2020, Commissioner Anderson released Bulletin 2020-02, requiring insurers to provide coronavirus testing and treatment without cost sharing. Additionally, the bulletin requires insurers to relax prior approval requirements and out-of-network requirements and procedures for participants who may need urgent testing and treatment. Employers can notify their plan participants that coronavirus testing and treatment will be provided without cost sharing.

Bulletin 2020-02 »


January 07, 2020

New Bulletin on Coverage for Tobacco Cessation Products Without Cost-Sharing

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On December 30, 2019, the Division of Insurance published Bulletin 2019-10, relating to state and federal requirements that carriers cover certain tobacco cessation products without consumer cost-sharing. According to the bulletin, on November 27, 2019, changes were made to Massachusetts law to enhance tobacco cessation benefits. Specifically, the new laws require carriers to provide members with coverage for tobacco cessation counseling and all generic US FDA-approved tobacco cessation products.

In addition, under federal law and as recommended by the US Preventive Services Task Force (USPSTF), preventive services must be provided without cost-sharing. Among the preventive services recommended by USPSTF is screening for all adults for tobacco use and providing tobacco cessation interventions for those who use tobacco. Therefore, when prescribed by a health care provider, carriers may not require any member cost-sharing for either tobacco cessation counseling or any of the generic FDA-approved tobacco cessation products. Those include nicotine gum, nicotine patch, nicotine lozenges, nicotine oral or nasal spray, nicotine inhaler, bupropion, and varenicline.

Employers with fully insured plans in Massachusetts should review the bulletin, although it contains no new employer compliance obligations.

Mass.gov, Tobacco Cessation Products without Consumer Cost-Sharing Bulletin 2019-10