Commonwealth of Massachusetts
Citizens' Guide to State Services

Published by
William Francis Galvin
Secretary of the Commonwealth
Citizen Information Service

Consumer: Insurance

D12 Division of Insurance

D13 Bureau of Managed Care

D14 Office of Patient Protection

D15 Insurance Fraud Bureau of Massachusetts

D16 Board of Appeal on Motor Vehicle Liability, Policies and Bonds

D17 Commonwealth Health Insurance Connector Authority


D12 Division of Insurance
Office of Consumer Affairs and Business Regulations
1000 Washington Street, 8th Floor
Boston, MA 02118-6200
Consumer Line: 617-521-7794
Toll Free: 1-877-563-4467
www.mass.gov/doi/

The Division of Insurance regulates all aspects of the insurance business in the Commonwealth including licensing of agents, brokers, and companies, examination of domestic and foreign insurance companies, and oversight of sales, marketing and claim practices. Consumers may address questions about all aspects of insurance to this office between 8:45 a.m. and 5:00 p.m. Consumer complaints must be made in person at the office during those hours or submitted in writing.


D13 Bureau of Managed Care
Division of Insurance
Office of Consumer Affairs and Business Regulations
1000 Washington Street, 8th Floor
Boston, MA 02118
Tel: 617-521-7372
www.mass.gov/doi/

This office was created by Chapter 141 of the Acts of 2000, in conjunction with the Department of Public Health’s Office of Patient Protection (see D14 below), to oversee and enforce compliance of health insurance carriers, insures, and HMOs operating in the state. Contact this office to file a complaint by phone, e-mail, or fax.


D14 Office of Patient Protection
Department of Public Health
50 Milk Street, 8th Floor
Boston, MA 02109
Toll Free: 1-800-436-7757 (within Mass. only)
Fax: 617-624-5046
www.mass.gov/dph/opp

The Office of Patient Protection, created by Chapter 141 of the Acts of 2000 and in operation since January 1, 2001, is charged with developing regulations and implementing new statutory provisions of M.G.L. Chapter 1760 for residents covered by a state carrier, insurer or HMO regarding their rights to understanding their health coverage’s internal grievance procedures, as well as establishing a process for obtaining an independent external review where coverage is denied based upon a medical necessity determination. An insured individual who receives an adverse determination of an internal grievance has the right to an external review of a covered benefit within 45 days, and may obtain the necessary forms by calling this office or by accessing the department’s website for a form. To file a complaint, contact the Division of Insurance’s new Bureau of Managed Care (see D13 above).


D15 Insurance Fraud Bureau of Massachusetts
101 Arch Street
Boston MA 02110-1131
Tel: 617-439-0439
Fax: 617-439-0404
Toll Free: 1-800-32-FRAUD (3-7283, 24-hours)
www.ifb.org/

The Insurance Fraud Bureau is a private entity licensed by the state under MGL Ch. 175A:8, was mandated by MGL Ch.266:111B (Ch. 338 of the Acts of 1990). Its purpose is to prevent and investigate fraudulent insurance transactions by insured individuals against their insurance company. These illegal transactions can be criminally prosecuted.


D16 Board of Appeal on Motor Vehicle Liability, Policies and Bonds
Division of Insurance
1000 Washington Street, 8th Floor
Boston, MA 02118
Tel: 617-521-7478
www.mass.gov/doi/

Accident surcharges may be appealed to the Board of Appeals within 30 days of receipt of the Merit Rating Surcharge Notice. Convictions of moving violations are considered surchargeable incidents and are not appealable to the board. Any action of the Registry of Motor Vehicles and automobile insurance cancellations may also be appealed to this board.


D17 Commonwealth Health Insurance Connector Authority
100 City Hall Plaza 6th Floor
Boston, MA 02108
Toll Free: 1-877-MA ENROLL (623-6765)
TTY Commonwealth Care: 1-877-623-7773
www.MahealthConnector.org/

The Commonwealth Health Insurance Connector Authority created by Chapter 58 of the Acts of 2006 and signed into law on April 12th, 2006 requires citizens on Massachusetts to have health insurance. Based upon income eligibility, those at or below 300% of the federal poverty level may enroll in a Commonwealth Care plan. Beginning in 2014, as a result of national health reform, all Massachusetts residents under 133 percent of the federal poverty level (FPL) will be eligible for MassHealth if they are citizens or qualified aliens. For example, a family of four that makes less than $31,000 a year may qualify for MassHealth. New federal tax credits designed to help people pay for their health insurance premiums will also become available. Prior to passage of the ACA, individuals and families in Massachusetts earning up to 300% FPL (about $35,000 for an individual and $70,000 for a family of four) could get help paying for their health insurance premiums. Starting in 2014, people with incomes up to 400% of the federal poverty level (about $45,000 for an individual and $94,000 for a family of four) may qualify for federal tax credits to lower the cost of their premiums when they purchase insurance plans through the Health Connector. State-Subsidized Health Plans: In addition to federal tax credits, Massachusetts offers additional savings to those who are eligible (those earning up to 300% FPL). ConnectorCare plans are a set of health insurance plans with lower premiums and lower out-of-pocket costs that are subsidized by the state, as well as by the federal government through national health reform. By shopping through the Health Connector, individuals can easily and quickly find out if they qualify for one of these plans.


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