805 CMR 1.02
Dependent(c), (d), or (e);
(g) A Child who is dependent upon an insured Employee, Retiree, or Surviving Spouse for
support and who lives in the Employee, Retiree, or Survivor's household, where there is
evidence of a parent-child relationship satisfactory to the Commission, younger than 26 years
old or two years after the child ceases to be an IRS dependent, whichever occurs first;
(h) A Student who is the Child of an insured Employee or Retiree, or of an insured
Employee's or Retiree's Spouse, Surviving Spouse or Former Spouse, and that Student's
Children, if any;
(i) A Handicapped Dependent as defined in 805 CMR 1.02: Handicapped Dependent;
(j) A Child of an insured Employee, Retiree, Spouse, Former Spouse, or Surviving Spouse,
younger than 26 years old.
Elderly Governmental Retirees. Employees who:
(a) retired from the Commonwealth or one of its political subdivisions before
January 1, 1956; and
(b) who are eligible for separate insurance coverage under the provisions of M.G.L. c. 32A,
§ 10B; or
(c) who retired from a city, town, or district that has accepted M.G.L. c. 32B, § 11B and
were pensioned before that city, town, or district accepted M.G.L. c. 32A, § 10B;
Emergency Employment. Employment for an unforeseen Employer emergency, limited to a
specified time period, usually not more than 30 days.
Employee. Person whose time is devoted to the service of the Commonwealth or one of its
political subdivisions that is authorized to participate in Commission benefit programs by
express reference in state law, who works during the Regular Work Week of permanent
employees and who contributes to a State pension system, a Housing, Redevelopment or
Optional Retirement Plan, or another public sector retirement system; or a person elected by
popular vote to state or local government office during the term that he or she holds office. State
and municipal board, Commission or authority members who do not work a Regular Work Week
and its requisite statutory hours are not Employees, unless expressly otherwise authorized by law.
Contributions to an OBRA Plan do not constitute contributions to a public retirement system.
Employer. The Commonwealth or one of its political subdivisions that participates in certain
Commission benefit programs by express statutory authority.
Family Health Coverage. Commission health coverage that includes a person entitled to and
enrolled in Commission coverage and his or her eligible dependents.
Former Spouse. A person who was formerly married to an Employee or Retiree and who has
been granted a judgment of divorce or of separate support by a court of competent jurisdiction.
Group Insurance Coordinator. The person at each reporting location who acts as a liaison
between the reporting location and the Commission on matters involving the employer's and its
employees' participation in the Commission's programs.
Half-time, Half-time Employees. Active employees who work at least 18.75 hours in a regular
work week of 37.5 hours, or 20 hours in a regular work week of 40 hours.
Handicapped Dependent. A Child of an insured Employee, Retiree or Surviving Spouse, 19
years of age or older, who:
(a)
upon attaining 19 years of age, was mentally or physically disabled and incapable of
earning his or her own living;
(b) earns an annual income of less than 200% of the Federal Poverty Level; and
(c)
if enrolling after 26 years of age, other than as the Dependent of a new Enrollee,
demonstrates satisfactory proof of involuntary loss of other coverage.
Health Care Spending Account. A pre-tax program through which active State Employees who
work at least Half Time pay through payroll deduction on a pre-tax basis for non-covered
health-related expenses.
Health Coverage, Health Insurance. Health benefits provided by the Commission to eligible
Employees and Retirees and their eligible dependents pursuant to M.G.L. chs. 32A and 32B.
Individual Health Coverage. Health Coverage for a person entitled to and enrolled in a
Commission health plan.
Insured. An Employee, Retiree, Survivor, or Dependent eligible for and enrolled in Commission
coverage.
Local Governmental Unit. A county, city, town or district that participates in the Commission's
Retired Municipal Teacher program.
Long-term Disability Insurance. An income replacement program that qualifies a State
Employee to receive a percentage of his or her gross monthly salary, tax-free, after illness or
injury renders him or her unable to work for more than 90 consecutive days.
Municipal Employee, Retiree, Survivor, or Dependent. An Employee, Retiree, Survivor, or
Dependent whose eligibility for Health Coverage derives from employment or prior employment
with a Municipal Employer.
Municipal Employer. A Massachusetts county, city, town or district that is an Employer by
virtue of having formally agreed or obtained an order to transfer its Employees, Retirees,
Survivors, and Dependents to Commission Coverage pursuant to M.G.L. c. 32B, § 19 or § 23,
including the city of Lawrence, to the extent it is deemed to have accepted M.G.L. c. 32B, § 19,
per St. 2010, c. 58, § 4(f).
Municipal Insured. A Municipal Employee, Retiree, Survivor, or Dependent eligible for and
enrolled in Commission coverage.
Nondiscriminatory Basis. Plans whose coverage does not contain any annual or lifetime dollar
or unit of service limitation imposed for care provided by one type of participating provider that
is less than any annual or lifetime dollar of unit of service limitation imposed on coverage for
the same services by other types of participating providers.
Nurse Practitioner. A Massachusetts licensed registered nurse in good standing who holds
authorization in advanced nursing practice as a nurse practitioner under M.G.L. c. 112, § 80B.
OBRA Plan. A deferred compensation plan that serves as an alternative to Social Security as
permitted by the federal Omnibus Budget Reconciliation Act of 1990, (PL101-508, 104 Stat.
1388).
Physician Assistant. A registered Massachusetts physician assistant in good standing who is
supervised by a registered physician in accordance with M.G.L. c. 112, §§ 9C through 9K.
Regular Work Week. An employee's work, in the service of an Employer of no fewer than 18.75
hours, regularly, in a position for which the established work week is 37.5 hours or no fewer than
20 hours, regularly, in a position for which the established work week is 40 hours, or which
meets other statutory requirements. Such hours averaged over any period of time do not
constitute a Regular Work Week.
Retired Municipal Teachers. Retired teachers of political subdivisions of the Commonwealth
that have accepted M.G.L. c. 32B, § 11E, whose applications for coverage are approved by the
Commission and who receive a pension from the State Teachers' Retirement Board and who are
not eligible for Elderly Governmental Retiree coverage.
Retiree. A person formerly in the service of the Commonwealth or one of its political
subdivisions that is authorized to participate in Commission benefit programs by express
reference in state law, whose services ended on or after January 1, 1956 and who are eligible for
and are receiving and continue to receive a retirement or pension allowance from a participating
retirement system, including from the Board of Higher Education's Optional Retirement
Program, but excluding any OBRA Plan.
Retirement. A status that entitles a former Employee to a pension or retirement allowance under
any general or special law, either at the time of employment termination or at some future date.
Seasonal Employment. Employment in a single position with recurring duties for a short
duration, usually for three months or less.
Separated Spouses. Spouses who are granted a judgment of separate support or other related
legal relief.
Spouse. Person joined in marriage, as recognized by state law, to an Employee or Retiree.
State Employee, Retiree, Dependent, or Survivor. An Employee, Retiree, Dependent, or
Survivor who is eligible for benefits pursuant to M.G.L. c. 32A. Retired Municipal Teachers and
Elderly Governmental Retirees are State Retirees. An Employee, Retiree, Dependent, or
Survivor who is eligible for benefits only pursuant to M.G.L. c. 32B, § 19 or § 23, is not a State
Employee, Retiree, Dependent, or Survivor.
Student. Child 19 years of age or older, but younger than 26 years old, who attends an accredited
educational or vocational institution on a full-time basis.
Surviving Dependent. A deceased insured Employee's or a deceased insured Retiree's Child
Dependent, who, younger than 26 years old, the Child had no surviving parent.
Surviving Handicapped Dependent. A deceased insured Employee's or a deceased insured
Retiree's Child Dependent, who has no surviving parent and, at the time of the survivor parent's
death, was covered by the Commission as a handicapped dependent.
Surviving Spouse. A widow or widower of an insured Employee or Retiree, until their death or
remarriage. Persons divorced or legally separated from insured Employees or Retirees are not
Surviving Spouses.
Survivor. A Surviving Spouse, Surviving Dependent, or Surviving Handicapped Dependent.