Sections 19, 20, 21, 22 & 23: Insurance Partnership Eligibility

(1) For purposes of this section, the following words shall have the following meanings:-- [unchanged text not shown] “Eligible employee”, an employee: (i) who is employed by an eligible employer; (ii) who resides in the commonwealth; (iii) who has not attained age 65; (iv) whose employer or family member's employer has not in the last 6 months provided insurance coverage for which the individual is eligible; and (v) who meets the financial and other eligibility standards set forth in regulations promulgated by the division, if the gross family income standard does not exceed 300 per cent of the federal poverty level.

“Eligible self-employed single individual”, a person with or without dependents (i) who receives any gross income from self-employment; (ii) who resides in the commonwealth; (iii) who has not attained age 65; and (iv) who meets the financial and other eligibility standards set forth in regulations promulgated by the division, provided that the gross family income standard shall not exceed 300 per cent of the federal poverty level.

“Eligible self-employed husband and wife”, a married couple with or without dependents (i) where either spouse receives any gross income from self employment; (ii) where both spouses reside in the commonwealth; (iii) where neither spouse has attained age 65; and (iv) who meets the financial and other eligibility standards set forth in regulations promulgated by the division, provided that the gross family income standard shall not exceed 300 per cent of the federal poverty level.

“Qualified medical insurance”, shall mean “qualified medical insurance”, “qualified individual medical insurance”, “qualified two-person family medical insurance” and “qualified family medical insurance” as defined in regulations promulgated by the commissioner of insurance pursuant to section 3C of chapter 175.

(2) The division may, subject to the provisions of this section, establish an insurance reimbursement program for certain employees and employers for the purpose of reducing or eliminating the amount of contributions or payments made by such employees and employers toward the cost of qualified medical insurance and which shall consist of the following three programs:

(A) an employee subsidy program to assist eligible employees with reducing or eliminating their contribution to premiums or other employment-based costs of qualified medical insurance provided by an eligible employer for which said employer pays not less than 50 per cent of said premium or cost; and provided, further, that the amount of said subsidies may vary with the contribution of said employees to the cost of their qualified medical insurance, and with the income of said employees and their families, in accordance with one or more sliding fee schedules set forth in regulations promulgated by the division and may be paid directly to or on behalf of said eligible employees; and, provided further, that the amount of the subsidy shall not be greater than that of the subsidy the employee would have received if enrolled in the subsidized insurance program under chapter 118H.

 

(B) a subsidy program to assist the self-employed single individual and the self-employed husband and wife with reducing the cost of premiums or other costs of purchasing qualified medical insurance; provided, however, that the amount of said subsidies may vary with the income or insurance costs of said persons and their families under 1 or more sliding fee schedules set forth in regulations promulgated by the division and may be paid directly to or on behalf of said persons; and provided further, that the amount of the subsidy shall not be greater than that of the subsidy the employee would have received if enrolled in the subsidized insurance program under chapter 118H.

 

(C) an employer health care incentive program for the purpose of reducing the cost to said employers of providing or maintaining qualified medical insurance for their eligible low-income employees; provided, however, that said eligible employer pays 50 per cent or more of the premium cost of such qualified medical insurance; and provided, further, that the division may limit payments under this program, using a reasonable methodology, in relation to the participation of said employer's employees in the subsidy program provided for in paragraph (A). No payments authorized under this paragraph shall be made to a self-employed individual or a self-employed husband and wife.


(3) The subsidy programs described in paragraphs (A) and (B) of subsection (2) shall constitute additional medical benefits to expansion beneficiaries in accordance with the terms and conditions of a demonstration project as defined in subsection (1) of section 9A. The division may, subject to the terms and conditions of said demonstration project, include in the demonstration project the program described in paragraph (C) of subsection (2); provided, however, that the division may implement said program if it is not included within said demonstration project.

(4) The amount of payments for each employer under paragraph (C) of subsection (2) shall be as follows: (i) $400 for each eligible employee for whom the eligible employer pays 50 per cent or more of the cost of qualified individual medical insurance; (ii) $800 for each eligible employee for whom the eligible employer pays 50 per cent or more of the cost of qualified two-person family medical insurance, and (iii) $1,000 for each eligible employee for whom the eligible employer pays 50 per cent or more of the cost of qualified family medical insurance; provided that the division may use any reasonable data sources in determining the number of eligible employees of an eligible employer qualifying for such payments under clauses (i), (ii) and (iii). [unchanged text not shown]

 

Summary: 

Expands employee eligibility for participation in the Insurance Partnership Program to 300% of the Federal Poverty Level. • Ensures that Insurance Partnership subsidies are consistent with those provided under the Commonwealth Care program. • Specifies that self-employed individuals enrolled in the Insurance Partnership Program are eligible for employee subsidies only.