Massachusetts General Laws
Chapter 176j - Small Group Health Insurance
Section 14 - Coverage of Medically Necessary and Covered Services Otherwise Unavailable Within Carrier's Provider Network

Section 14. If a medically necessary and covered service is not available to a member within the carrier's provider network, the carrier shall cover the services out-of-network, for as long as the service is unavailable in-network.

Structure Massachusetts General Laws

Massachusetts General Laws

Part I - Administration of the Government

Title XXII - Corporations

Chapter 176j - Small Group Health Insurance

Section 1 - Definitions

Section 2 - Application of Chapter

Section 3 - Individual and Small Group Plans; Group Base Premium Rate; Filing Plan With Connector; Investigation of Deviations From Group Base Premium Rate

Section 4 - Carriers to Make Health Benefit Plans Available; Renewal of Plans

Section 5 - Exclusion of Eligible Individuals

Section 6 - Approval of Health Insurance Policies; Eligibility Criteria; Submission of Information; Approval of Changes to Small Group Product Base Rates or Rating Factors

Section 7 - Disclosure by Carriers

Section 8 - Transitional Reinsurance Program

Section 9 - Continuous Coverage

Section 10 - Young Adult Health Benefit Plans; Coverage Requirements; Premiums

Section 11 - Reduced or Selective Network Plans; Tiered Network Plans; Smart Tiering Plans

Section 11a - Continuing Coverage for Active Course of Treatment for Serious Disease Begun Prior to Enrollment in Reduced or Selective Network Plan or Tiered Network Plan

Section 12 - Small Business Group Purchasing Cooperatives; Regulations Governing Establishment, Oversight and Certification

Section 13 - Filing of Health Benefit Plan Proposals for Consideration Upon Request of Group Purchasing Cooperative

Section 14 - Coverage of Medically Necessary and Covered Services Otherwise Unavailable Within Carrier's Provider Network

Section 15 - Display by Insurer Offering Tiered Network Plan of Cost-Sharing Differences for Enrollees in Various Tiers in Promotional and Agreement Material

Section 16 - Attribution of Members to a Primary Care Provider

Section 17 - Disclosure of Patient-Level Data and Contracted Prices of Individual Health Care Services by Carriers to Providers