Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 146.00 - Specified Disease Insurance
Section 146.06 - Minimum Benefit Standards for Individual Policies Written on an Indemnity and Recurring Basis

(1) Notwithstanding any other provisions of 211 CMR 146.06, an individual policy shall provide benefits to any covered person not only for the specified disease(s) but also for any other condition(s) or disease(s) directly caused or aggravated by the specified disease(s) or the treatment of the specified disease(s).

(2) If payments are to be conditioned upon a covered person receiving medically necessary care or treatment, given in a medically appropriate location, under a medically accepted course of diagnosis or treatment, this is to be clearly stated in the policy and the carrier must be accredited pursuant to M.G.L. c. 176O and 211 CMR 146.000.

(3) No individual policy or certificate issued pursuant to 211 CMR 146.06 shall contain a waiting period lasting longer than 30 days from the coverage effective date. A provision shall be included in the policy or certificate indicating that for a specified disease diagnosed within the initial 30 days of coverage, the policy or certificate is either void from its beginning with a full premium refund to the insured, or the coverage for such diagnosed specified disease is subject to a pre-existing condition limitation not exceeding six month from the coverage effective date. The provision shall also indicate that the insured must elect whether the policy or certificate is to be voided with a full premium refund or coverage is to be delayed.

(4) Except as otherwise noted in 211 CMR 146.06, an individual specified disease policy's benefits shall begin with the first day of medical care or hospital confinement if such care or confinement is for a covered disease, even though the diagnosis is made at some later date.

(5) Benefits for confinement in a skilled nursing home or for home health care are optional. If a policy or certificate provides these benefits, the coverage must equal a fixed sum payment of at least one-half of the hospital confinement in-patient benefit for each day of skilled nursing home confinement for at least 100 days, and a fixed sum payment of at least 1/2 of the hospital confinement in-patient benefit for each day of home health care for at least 100 days. Notwithstanding any other provision of this Part, any restriction or limitation applied to the benefits in the above requirements, whether by definition or otherwise, shall be no more restrictive than those under title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq., 1395j et seq.).

(6) If benefits are not payable for a period of 180 days, then a covered person shall be entitled to a new benefit period.