Business - Massachusetts Health Connector

Employer Appeals

Right to Appeal If you do not agree with our decision about whether or not you are an eligible employer, you have a right to appeal our decision and receive a hearing. Employers have the right to appeal a denial of eligibility, the failure of Health Connector to provide a timely eligibility determination, or the failure of the Health Connector to provide a timely notice of an eligibility determination. You have 90 days from the date of the eligibility notice to request an appeal. If you do not appeal within 90 days, you may lose your appeal right. Appeals vs. Grievances Employers may appeal our decisions regarding whether a small business meets our employer eligibility requirements, as defined in our policy. If an employer or employee has a grievance, the issue may not be appealable. We ask that individuals contact our customer service to further discuss any grievances they may have. Appealable Grievances Business location in Massachusetts Number of full-time equivalent employees Employee enrollment issues Billing issues Dissatisfaction with benefits How to File an Appeal You may appeal by completing a Health Connector Small Group Request for Hearing Form (docx). You may mail or fax the form. Mail: Health Connector Appeals Unit, PO Box 960189, Boston, MA 02196 Fax: 1-617-933-3099 Appeals Process Once we receive your appeal, it triggers both an informal and formal review process. Informal Review You may be contacted by a staff member within the Health Connector to review your eligibility and enrollment history with [...]

Can I leave my employer-sponsored insurance (ESI) in the middle of the plan year?

When someone enrolls in health coverage through their employer, they are generally making that selection for the full plan year under federal rules. They may only make changes during their employer’s annual open enrollment period. However, federal rules provide specific scenarios when an employee can make mid-year plan changes. To make any mid-year changes, the employee must experience a qualifying mid-year election change event recognized by federal rules and allowed by their employer. Some examples of these qualifying events include: Marriage, divorce, or legal separation Change in number of dependents (for example, childbirth or adoption) Involuntary loss of coverage under another plan Change in employment status For any questions regarding mid-year plan changes, including dropping coverage through your employer, it’s important to speak to your employer.[1] If you have questions and would like to speak with someone, call Customer Service at 1-877-MA-ENROLL (1-877-623-6765) or TTY: 711, or find an Enrollment Assister location near you. For more information, please see: What to Know If You Get Help Paying for Health Insurance from Both the Health Connector and Your Employer – Massachusetts Health Connector Job-based Insurance Affordability Calculator - Premium Tax Credit Department of Labor information on Continuation of Health Coverage – COBRA Massachusetts Division of Insurance MiniCobra Continuation of Coverage Benefits Guide Tax Treatment of Cafeteria Plans – Final Regulation __________ [1] See Tax Treatment of Cafeteria Plans on IRS.gov: https://www.irs.gov/pub/irs-regs/td8921.pdf

Can I get Health Connector coverage if I do not want my employer-sponsored insurance (ESI)?

You can switch out of your employer’s plan to a Health Connector plan during your employer’s annual open enrollment period. Even if you could continue on your employer’s plan, the ending of that plan would trigger a special enrollment opportunity for you to sign up for Health Connector coverage. An employee is not eligible to receive subsidies through the Health Connector if their employer-sponsored coverage is considered affordable (according to a federal definition) and provides minimum value coverage. However, as noted below, an employee is not eligible to receive subsidies through the Health Connector if their employer-sponsored coverage is considered affordable (according to a federal definition) and provides “minimum value” coverage. If you are not in your employer’s annual open enrollment period, you would need to experience a qualifying mid-year election change event to leave the employer’s plan. If you leave your employer’s plan, you may apply for and enroll in Health Connector coverage. If you do not have a qualifying mid-year election change event to leave your employer’s plan, and you still want to apply for and enroll in Health Connector coverage, please know that you will need to experience a qualifying event to enroll with the Health Connector and you would be covered by both your employer plan and Health Connector plan. That means that you would be paying for double coverage.

Can I get subsidies through the Health Connector if I choose to leave my employer-sponsored insurance (ESI)?

An employee is not eligible to receive subsidies through the Health Connector if their employer-sponsored coverage is considered affordable (according to a federal definition) and provides “minimum value” coverage. Employer-sponsored coverage is considered affordable if the portion of the annual premium you must pay for self-only coverage does not exceed the annually adjusted percentage of household income set by the IRS, which is9.02% in 2025 and 9.96% in 2026. Employer-sponsored coverage is considered to meet “minimum value” standards if the plan covers at least 60 percent of the total allowed cost of benefits expected to be incurred under the plan. The plan also must provide substantial coverage of in-patient hospitalization and physician services. Most employer plans meet this standard. The Health Connector has a tool located here to help you calculate the affordability of your job-based coverage.

Consumer Protections Against Surprise Billing through the No Surprises Act

The No Surprises Act protects people from getting surprise medical bills when they have an emergency, get services from an out-of-network provider at an in-network facility, or get services from an out-of-network air ambulance service provider. It also establishes a process for payment disputes between plans and providers. It provides new opportunities for dispute resolution for people who are uninsured or self-pay individuals when they receive a medical bill that is much greater than the good faith estimate they get from the provider. If you have private health insurance, the protections ban most types of surprise bills. If you're uninsured or decide not to use your health insurance for a service, you can get an estimate of the cost of care before your visit. If you disagree with your bill, you may be able to dispute the charges. Here are some frequently asked questions about the No Surprises Act: Am I protected against surprise medical bills? In 2022, the federal No Surprises Act (NSA) established new protections that prevent surprise medical bills for individuals covered under group and individual health plans. These new protections ban the most common types of surprise bills. What types of surprise medical bills does the No Surprises Act protect against? The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive: most emergency services; non-emergency services from out-of-network providers at in-network facilities; and services from out-of-network air ambulance service providers. It also establishes a [...]

What to Know If Your Small Business Is Considering a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA)

Employers should consider the full financial impact a QSEHRA could have on their employees’ premium costs. While QSEHRAs can help reduce employees’ health care costs, QSEHRAs can increase health care costs for some employees who purchase individual health plan coverage through the Health Connector and receive premium tax credits or ConnectorCare state premium subsidies. Under federal tax law, employees cannot get both a QSEHRA benefit from their employer and a full premium tax credit through the Health Connector. If an employee qualifies for a premium tax credit through the Health Connector, and their employer offers a QSEHRA benefit (even if the employee does not use it), the employee’s premium tax credit amount will be reduced or eliminated by the federal government when they file taxes and the employee will have to pay the federal government back either some or all of their premium tax credit amount. For more information about how QSEHRAs work and what employees should know about QSEHRAs, please visit https://www.mahealthconnector.org/help-center-answers/hra-and-your-aptc The following example demonstrates how an employee’s costs may increase if they are eligible for premium tax credits and their employer provides a QSEHRA:[1] Consider an employee in Boston earning 200% of the federal poverty level (FPL) or $24,280 annually. Under current law, she would be eligible for an APTC of $140 and a ConnectorCare state premium subsidy of $49. Her employer cannot afford group coverage but decides to make a QSEHRA contribution of $100 per month. The QSEHRA offered to the employee is considered affordable coverage [...]

Assigning, Changing, and Terminating a Broker

Who is this guide for? Employers who want to assign, change or remove a broker for their Employer account on Health Connector for Business. Step 1: After logging in to your Health Connector Employer account, click the "Brokers" tab on the left- hand side of your account page under My Health Connector. Step 2: Search for your Broker by name or by agency. Step 3: Once you've found the Broker you want, click "Select Broker." Step 4: You will need to confirm your Broker selection by clicking the red "CONFIRM" button. Another way to search for a Broker is on our Get Expert Help page: http://my.mahealthconnector.org/enrollment-assisters Changing or Terminating a Broker Step 1: If you need to change the broker you selected, login to your Health Connector Employer account and click "Change Broker". Step 2: Next, click "Terminate Broker" to return to the Broker browsing screen. Step 3: If you want to assign a new broker, please reference the "Assigning a Broker" steps above.

Guide to Making Payments to Your Business Account

How to pay your premiums online This guide shows Small Business owners how to pay health insurance premiums online through secure electronic check payment in your Health Connector for Business account. It covers: Making your first payment (binder payment) Setting up or deleting recurring payments (AutoPay) Making a one-time payment Making Your First Payment (Binder) Your first payment is called your binder payment. You must follow these steps to make your first payment. If you would like to set up AutoPay, you can do so after making your binder payment. Step 1. Login to your Health Connector employer account. Step 2. Select "Billing" from the left menu. Step 3. Select the "Statements" tab to view the invoice for your first month of coverage. Record the total amount due – you will need it when you set up your payment. Step 4. Select the "Pay My Bill" tab. Step 5. Select "Pay Online". Step 6. Select "Pay Online". Step 7. Select 'Pay My Bills'. Step 8. Select the row that says 'Due Date' and 'Payment Note'. You'll see a row with 'Health Connector for Business Account Number 1' expand below. Step 9. Select 'Initial Binder Payment from drop down menu Step 10. Enter the total amount due from your invoice. Step 11. Select 'Add A Payment Method'. Step 12. Enter bank account information. Select 'Add'. Important: Double check your routing and account numbers to make sure we process your payment [...]

Qualifying Life Events (QLEs) – Terminating Coverage

Throughout the year your circumstances may change which may make you eligible for a Special Enrollment Period (SEP). If you have a baby, you or your dependent gain or lose other coverage, etc., you may be able to change your plan, enroll in a plan for the first time, add or drop family members, or terminate your plan. You must report the event WITHIN 30 DAYS of the event to be eligible for an SEP. Once you report the event in your account, DC Health Link will guide you through the options available to you and your family. Step 1: Report the Qualifying Life Event In each employee's account, consumers will have the option to report a qualifying life event. Please select the life event that applies to the primary subscriber or dependent (For Example: "Drop coverage due to new eligibility"). Note: There are three different pages of QLEs that can be viewed by clicking the arrow Step 2: Enter the Date of QLE Report the date of your qualifying event by selecting the date from the calendar or keying in the date. Then click "Continue". Step 3: Confirm the QLE If you are eligible to apply for a SEP, a green confirmation box will appear. Click "Continue" to proceed. Step 4: Confirm Household Once you have confirmed your household, click the "Continue" button. Step 5: Select Waive Coverage Click "Waive Coverage" for the plan that you wish to terminate. Step 6: Select Waiver Reason Select the reason why [...]

Qualifying Life Events (QLEs) – Removing a Dependent

Throughout the year your circumstances may change which may make you eligible for a Special Enrollment Period (SEP). If you have a baby, you or your dependent gain or lose other coverage, etc., you may be able to change your plan, enroll in a plan for the first time, add or drop family members, or terminate your plan. You must report the event WITHIN 30 DAYS of the event to be eligible for an SEP. Once you report the event in your account, the Health Connector will guide you through the options available to you and your family. Step 1: Report the Qualifying Life Event In each employee's account on www.MAhealthconnector.org, consumers will have the option to report a qualifying life event. Please select the life event that applies to the primary subscriber or dependent (For Example: Divorced or ended domestic partnership, Drop Family Member due to new Eligibility). Note: There are three different pages of QLEs that can be viewed by clicking the arrow Step 2: Enter the Date of QLE Report the date of your qualifying event by selecting the date from the calendar or keying in the date. Then click "Continue". Step 3: Confirm the QLE If you are eligible to apply for a SEP, a green confirmation box will appear. Click "Continue" to proceed. Step 4: Update Household You will be able to add/remove any members of your household. In the next steps you will have the option to add/remove any dependent from the policy [...]