Code of Massachusetts Regulations
940 CMR - OFFICE OF THE ATTORNEY GENERAL
Title 940 CMR 9.00 - Group Health Care Insurers, Termination Of Coverage
Section 9.05 - Written Notice of Termination

Universal Citation: 940 MA Code of Regs 940.9

Current through Register 1531, September 27, 2024

(1) Home Address. A Group Health Care Insurer will satisfy the written notice condition set forth in 940 CMR 9.04 by mailing, to the last-known home address of the Subscriber, a letter that includes the following information:

(a) the date on which the Sponsor's Group Health Insurance Plan was terminated;

(b) that the termination was for nonpayment of fees, charges, rates or premiums; and

(c) that the Group Health Care Insurer will honor claims, to the extent covered under the Group Health Insurance Plan, for any covered health care service received by the Subscriber or his or her Covered Dependents prior to the notification date. The Group Health Care Insurer must send the letter by either first-class or certified mail, postage pre-paid.

(2) Reasonable Efforts. A Group Health Care Insurer must make a reasonable effort to determine the accurate names and home addresses of Subscribers. A Group Health Care Insurer will be deemed to have made a reasonable effort under 940 CMR 9.05 if it has made a written request, within one year before the notice of termination, that a Sponsor provide it with the current names and home addresses of all Subscribers. A Group Health Care Insurer may rely upon the accuracy of the name and address information supplied by a Sponsor, Subscriber or other reliable source within one year before the notice of termination.

(3) Work Address. If a Group Health Care Insurer, after reasonable efforts, is unable to obtain the home address of a Subscriber, it will satisfy its obligations under 940 CMR 9.05 by mailing the notice to the Subscriber at his or her last-known work address.

(4) Effective Date of Notice. Notice of termination will be deemed effective three days after the date on which the Group Health Care Insurer mailed it to the Subscriber. The Group Health Care Insurer will have the burden of proving that it mailed the notice in a manner consistent with 940 CMR 9.05.

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