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Important Direct Pay Eligibility Changes

2010 Direct Pay Eligibility Changes for Individual Coverage: What You Need to Know

Eligibility Requirements
Beginning October 1, 2010, Massachusetts residents who are eligible for coverage through an employer-sponsored (group) plan will be ineligible for coverage in the individual (non-group) market.

Massachusetts residents must establish that they are ineligible for coverage through an employer-sponsored plan to be eligible for coverage in the individual market.

After October 1, 2010, it will be considered an unfair or deceptive practice to arrange for an employee to apply for individual coverage to reduce costs for an employer-sponsored plan.

Enrollment Requirements
Beginning December 1, 2010, Massachusetts residents will only be able to enroll in a plan in the individual market during the 45-day Open Enrollment period, unless they meet certain criteria:

  • July 1 to August 15

Massachusetts residents may only obtain individual coverage outside of an Open Enrollment period if they establish that they requested non-group coverage within 63 days of termination of prior creditable coverage held for 18 or more months under a group health plan, governmental plan, or church plan. Additional restrictions may apply.

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