Requires that the age rate adjustment factor, used by health plans to calculate rates for eligible individuals and small groups, be applied on a year to year basis in order to more evenly distribute the rate of increase. In addition to age, an insurer may also calculate rates based on an individual’s or small group’s business industry, participation rate of members, wellness program discount, and tobacco use. The maximum premium rate offered to members cannot exceed 2 times the lowest premium rate offered to members within a particular class of business.

Defines "wellness program" or "health management program" to indicate a program designed to improve the overall health of participants.

Defines "small business group purchasing cooperative" that may be used interchangeably with "group purchasing cooperative" to indicate a nonprofit or not-for-profit corporation or association, certified as a qualified association, that negotiates health coverage for all its members with one or more health plans.

Defines "qualified association" to include a Massachusetts nonprofit or not-for-profit corporation or organization focused on advancing the occupational, professional, trade, or industry interests, other than obtaining health insurance, of association members.

The organization must be active for at least 5 years before seeking qualified association status and must have at least 100 members, including individuals or small businesses that are actively involved in the organization and attained membership without regard to health status.

Amends the definition of “eligible individual” to restrict eligibility for individual coverage to individuals who are not seeking to replace employer-sponsored coverage that complies with minimum creditable coverage standards.

Adds 3 seats to the Health Care Quality and Cost Council (QCC), including representatives of small and large business and a licensed clinician. Members of the QCC must vote annually to select a chair and new 4-member executive committee. The QCC is also designated as an independent public entity, not subject to the supervision and control of any other executive office. The QCC will no longer be permitted to meet in Executive Session.

Modifies the definition of unfair or deceptive insurance practices by including insurers that arrange for an employee to apply for individual health insurance coverage for the purpose of then excluding that employee from an employer-sponsored health plan, for which the employee is eligible, to reduce costs for other individuals in the employer-sponsored health plan.

Modifies definition of unfair or deceptive insurance acts to include health plan insurance contracts that base reimbursement rates to a health care provider by reference to the price paid, or the average of prices paid, to that provider from any other plan. In addition, an insurer may not refuse to negotiate with a provider based on that provider’s other contracts, type of license, or affiliation with other health plans.

In general, an insurance company must not falsely advertise or misrepresent the nature of an insurance policy or its benefits, discriminate between similarly situated individuals in determining benefits eligibility, engage in unfair claim settlement practices, or fail to maintain a record of grievances.

Expands the existing infertility mandate to require coverage for women over age 35 who are unable to conceive for at least 6 months. Length of time necessary for women under age 35 remains at 1 year. This section applies to plans offered by Blue Cross Blue Shield of Massachusetts.

If a woman conceives but is unable to carry the pregnancy to live birth, the time she attempted to conceive prior to that pregnancy is to be included in the 1 year or 6 month calculation.

Expands the existing infertility mandate to require coverage for women over age 35 who are unable to conceive for at least 6 months. Length of time necessary for women under age 35 remains at 1 year. This section applies to plans offered by Blue Cross Blue Shield of Massachusetts. If a woman conceives but is unable to carry the pregnancy to live birth, the time she attempted to conceive prior to that pregnancy is to be included in the 1 year or 6 month calculation.