Requires that the Health Connector give at least 90 days notice to the legislature before implementing any changes to minimum creditable coverage standards.

In addition to establishing the standards for minimum creditable coverage, other responsibilities assigned to the Health Connector Board include offering insurance products to individuals and small businesses, publishing a schedule for premiums at which individuals of varying ages are eligible, and establishing a schedule for affordability to be used in enforcing the individual mandate based upon percentage of income eligible to be spent on health care.

Expands the Connector Board from 10 to 11 members to include a seat for a member of the Massachusetts chapter of the National Association of Health Underwriters to be appointed by the governor. The Commonwealth Health Connector is an independent public authority established under the 2006 health reform law (Chapter 58) to set health reform policies and offer subsidized coverage to low-income adults and allow for comparison and purchase of non-subsidized private health insurance plans to individuals and groups. The Secretary for Administration and Finance serves as chairperson. Each person appointed to the Board may serve a term of 3 years and may be eligible for reappointment.

Restricts eligibility for individual coverage through the Health Connector to individuals who are not seeking to replace employer-sponsored coverage that complies with minimum creditable coverage standards.

Requires insurance carriers, including third party administrators of insurance plans, to report information to the Division of Insurance (DOI) on premiums earned, membership, medical loss ratio, and other detailed financial information associated with business operations. Carriers must annually report this information to DOI each April 1st to avoid a late penalty and may subsequently be subject to an audit. Information collected under this provision will be available to the public, and DOI must issue an annual report of information collected under this provision to the legislature. Any carrier that reports a risk-based capital ratio over 700% must participate in a public hearing to determine what portion of excess funds will go toward reducing the costs of health benefit plans or for health care quality improvement.

DOI may develop procedures to carry out the requirements of this section, including requiring the registration of third party administrators and standardizing reporting criteria, after consulting with state and federal agencies and affected carriers to ensure that regulations are not duplicative.

Adds new definition of "wellness program" to the Group Insurance Commission statute.

Prohibits certain contracting practices between insurance carriers and health care providers including the following: provisions that guarantee a health care provider the right to participate in a select network or tiered network plan; requirements that all members of a provider group be included in the same tier in a tiered network plan or all be included in a select network plan; requiring provider participation in a new select or tiered network plan without granting providers the right to opt out of the new plans; requiring or permitting carriers or providers to alter contracts based on agreements with other carriers and providers; and requiring or permitting carriers to make supplemental payments without first publicly disclosing the amount and purpose of each such supplemental payment to the Insurance Commissioner.

Adds to the information insurers must provide to consumers to include the location, specialty, and methods of compensation or reimbursement for each provider in a plan’s network, a provider’s price relativity, health status adjusted total medical expense, and quality performance based on measures from the Standard Quality Measure Set standards developed by the Department of Public Health. The information specific to each provider in a carrier’s network must be provided on a health insurance carrier’s website, to at least one plan member per subscriber household, and to each prospective insured upon request.

The Bureau of Managed Care within the Division of Insurance (DOI) is directed to require, as a condition of accreditation, that carriers adopt uniform standards and methodologies for credentialing health care providers. Also, any carrier that contracts with a third party administrator must ensure that the third party complies with the standards. By way of background, the Bureau of Managed Care within DOI determines standards and procedures for accreditation of health insurance carriers. The Bureau must consult with the Division of Health Care Finance and Policy, the Department of Public Health, the Group Insurance Commission, the Centers for Medicare and Medicaid Services, and each health insurance carrier to develop the standards.

Amended to allow a carrier to seek approval from the Commissioner of the Division of Insurance (DOI) to discontinue a closed guarantee issue health plan pursuant to DOI regulations. Prior to this amendment, a carrier could only discontinue a closed guarantee issue health plan if the number of subscribers in the plan was less than 25% of the plan’s 2004 subscriber total. Furthermore, no carrier may deny coverage to, impose any pre-existing condition exclusion, or impose any waiting period on an individual or dependent who is eligible for a guaranteed issue health plan.

Amended to clarify that carriers offering coverage to individuals, including those who renew through the Connector, are considered to be participating in the nongroup health insurance market.

By way of background, any carrier that offers health plans in the small business market to more than 5,000 employees and dependents, and offers eligible individuals a guaranteed issue managed care plan, a guaranteed issue medical plan, or a guaranteed issue preferred provider plan will be included in the nongroup health insurance market.