Code of Massachusetts Regulations 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY
Here’s an overview of 956 CMR – Commonwealth Health Insurance Connector Authority, the set of Massachusetts regulations governing the Health Connector:
🔍 Regulatory Structure of 956 CMR
1. Coverage Requirements & Mandates
5.00 – Minimum Creditable Coverage
Defines what constitutes acceptable health insurance coverage—core services, preventive care, mental health, out‑of‑pocket limits, deductibles, etc. (betterhealthconnector.com)
6.00 – Affordability for Individual Mandate
Sets criteria making coverage financially accessible under state mandate. (law.cornell.edu)
2. Programs & Populations
7.00 – Small Group Wellness Incentives
Outlines incentives for small-employer health plans to encourage wellness programs. (law.cornell.edu)
8.00 – Student Health Insurance Program
Establishes health insurance requirements and waivers for higher-education students in Massachusetts. (law.cornell.edu)
3. Employer Requirements & Reporting
9.00 – Employer Surcharge
Details surcharges on employers who don’t provide required insurance for employees. (regulations.justia.com, mass.gov)
10.00 – Health Insurance Responsibility Disclosure
Requires employers to file and disclose their insurance coverage status. (regulations.justia.com)
11.00 – Fair Share Contribution
Specifies employer contribution standards to meet the "fair and reasonable" requirement under Massachusetts law. (law.cornell.edu)
4. Individual Enrollment & Appeals
12.00 – Eligibility, Enrollment, and Hearing Process
Addresses who qualifies, how to enroll, payment responsibilities, disenrollment rules, and appeal procedures. Regulations updated as of Dec 8, 2023. (mass.gov)
5. Market Operations
13.00 – Risk Adjustment Procedures
Outlines how risk is balanced among insurers in the non-group and small-group markets. (law.cornell.edu, mass.gov)
📌 How to Access the Regulations
| Format | Content | Notes |
|---|---|---|
| PDF downloads | Each subpart is available individually via mass.gov or Connector website. For example, 956 CMR 5.00 PDF covers definitions & minimum coverage (betterhealthconnector.com) | |
| Mass.gov HTML | The law library offers an overview page with links to major sections | |
| Justia / Cornell LII | Annotated versions with navigation between sub-titles |
📘 Quick Guide
Start: Review 956 CMR 5.00 to ensure any plan meets the minimum state coverage.
Check: Under 6.00 if your plan is considered affordable.
If employer: Review 9.00–11.00 to see if you’re subject to surcharges, disclosures, or contribution mandates.
If individual or student: Look at 8.00 (students) or 12.00 (general eligibility/enrollment/hearings).
For insurers: Consult 13.00 for risk adjustment rules.
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