940 CMR 26.04
Required Disclosures of Material Information
(1) It is an unfair or deceptive act in violation ofM.G.L. c. 93A, § 2(a) for a Discount Health
Plan or Discount Health Plan Organization to fail to disclose at the time of initial contact to a
prospective member and in all advertisements, brochures or marketing material, the following
material information:
(a) that the plan is not insurance coverage and does not meet the minimum creditable
coverage requirements under M.G.L. c. 11 lM and 956 CMR 5.00;
(b) for a plan offering a range of discounts, that the range of discounts for specified medical,
pharmacy or ancillary services provided under the plan will vary depending upon the type of
provider and the type of services received;
(c)
that the discount health plan does not make any payments to providers for services
received;
(d) that the plan member is obligated to pay for all services provided by providers that
participate in the discount plan but will receive a discount on services provided by providers
who have contracted with the discount health plan organization;
(e)
the name and contact information of the discount health plan, including mailing
address, telephone number and email address, if any; and
(f)
a toll-free telephone number and website address for the discount health plan
organization for prospective members and members to obtain additional information about
and assistance on the plan and up-to-date lists of providers participating in the discount
health plan.
940 CMR-180
For purposes of 940 CMR 26.04(1 ), disclosure means in writing in a clear and conspicuous
manner on the first content page of any advertisements, marketing materials or brochures made
available to the public relating to a discount health plan and on any enrollment forms given to
an individual. If the initial contact with a prospective member is in person or by telephone,
disclosure must be made during such initial contact by means of a clear oral explanation prior
to any solicitation orrequestfor payment and followed, prior to enrollment, by written disclosure
as required by 940 CMR 26.04.
(2) It is an unfair or deceptive act in violation ofM.G.L. c. 93A, § 2(a) for a Discount Health
Plan or Discount Health Plan Organization to fail to provide to:
(a)
each prospective member, at the time of enrollment, information that describes the
terms and conditions of the discount health plan, including any limitations or restrictions on
the refund of any processing fees or periodic charges associated with the discount health
plan; and
(b) each new member a written document that contains the specific terms and conditions
of the discount health plan.
For purposes of 940 CMR 26.04, specific terms and conditions of the discount health
plan include but are not limited to:
1. the discounts or range of discounts provided, expressed as a percentage or as a dollar
amount;
2. a current list of Providers or Provider Networks that provide discounts to members,
directly or by reference to a website containing such a list;
3. any fees or periodic charges associated with the discount health plan, including any
limitations or restrictions on the refund of any fees or periodic charges and the mode of
payment of any fees or periodic charges and procedures for changing the mode of
payment; any limitations, exclusions, exceptions or waiting periods regarding the receipt
of discounts under the discount health plan;
4. the procedures for obtaining discounts under the discount health plan; cancellation
procedures and refund requirements renewal, termination and cancellation terms and
conditions;
5. the procedures for filing complaints with the discount health plan organization; and
6.
the name and mailing address and phone number of the discount health plan
organization.
(c) Itis an unfair or deceptive act in violation ofM.G.L. c. 93A, § 2(a) for a discount health
plan organization to fail to maintain on its website an up-to-date list of the names and
addresses of the providers with which it has contracted directly or through a provider
network, which website address shall be prominently displayed on all advertisements,
marketing materials, brochures and discount health plan cards.