Section 5A. (a) In the event of the granting of a judgment absolute of divorce or of separate support to which a member of a group health maintenance contract is a party, the person who was the spouse of said member prior to the issuance of such judgment shall be and remain eligible for benefits under said contract, whether or not said judgment was entered prior to the effective date of said contract, without additional premium or examination therefor, as if said judgment had not been entered; provided, however, that such eligibility shall not be required if said judgment so provides. Such eligibility shall continue through the member's participation in the contract until the remarriage of either the member or such spouse, or until such time as provided by said judgment, whichever is earlier.
(b) In the event of the remarriage of the member referred to in paragraph (a), the former spouse thereafter shall have the right, if so provided in said judgment, to continue to receive benefits as are available to the member, by means of the addition of a rider to the family contract or the issuance of an individual contract, either of which may be at additional premium rates determined by the commissioner of insurance to be just and reasonable in accordance with the additional insuring risks involved.
(c) The name, address, and policy number of a person eligible for health insurance coverage pursuant to paragraph (a) or (b), if available, shall be forwarded by such health maintenance organization to the department of public welfare within thirty days of the date when coverage of said person under said paragraph (a) or (b) is commenced.
(d) Notice of cancellation of coverage of the divorced or separated spouse of a member shall be mailed to such divorced or separated spouse at such person's last known address, together with notice of the right to reinstate coverage retroactively to the date of cancellation.
(e) Claims paid on behalf of a divorced or separated spouse or on behalf of a dependent who is not residing with the member shall be paid to the physician, hospital or other provider of covered services or to the person on whose behalf such services were performed, unless the person is a minor child. In the event the person on whose behalf such services were performed is a minor, payment shall be made to the physician, hospital or other provider of such services or to the parent or custodian with whom the child resides.
Structure Massachusetts General Laws
Part I - Administration of the Government
Chapter 176g - Health Maintenance Organizations
Section 2 - Application of Laws
Section 3 - Organization; Accounting; Contracts
Section 4 - Required Coverage for Certain Conditions and Groups
Section 4a - Employees Terminated Due to Plant Closings; Coverage
Section 4b - Confidentiality of Information; Mental or Nervous Condition; Exceptions
Section 4c - Home Care Benefits
Section 4d - Nonprescription Enteral Formulas for Home Use
Section 4e - Off-Label Drug Use; Cancer Treatment
Section 4f - Group Health Maintenance Contracts; Coverage for Bone Marrow Transplants
Section 4g - Off-Label Use of Prescription Drugs for HIV/AIDS Treatment
Section 4h - Items Medically Necessary for Diagnosis and Treatment of Diabetes
Section 4i - Prenatal, Childbirth and Postpartum Care Benefits; Minimum Coverage for In-Patient Care
Section 4j - Scalp Hair Prostheses Necessary Due to Cancer or Leukemia Treatment
Section 4k - Newborn Hearing Screening Tests
Section 4l - Coverage for Hospice Services
Section 4n - Coverage for Speech, Hearing and Language Disorders; Hearing AIDS
Section 4p - Patient Care Services Provided Pursuant to Qualified Clinical Trials
Section 4q - Coverage for Human Leukocyte or Histocompatibility Locus Antigen Testing
Section 4s - Coverage for Prosthetic Devices and Repairs
Section 4t - Coverage for Eligible Dependents Under 26 Years of Age
Section 4u - Coverage for Medically Necessary Hypodermic Syringes or Needles
Section 4v - Coverage for Diagnosis and Treatment of Autism Spectrum Disorder
Section 4w - Coverage for Children Under Age 18 for Cleft Lip and Cleft Palate
Section 4x - Coverage for Orally Administered Anticancer Medications
Section 4y - Coverage for Abuse Deterrent Opioid Drug Products
Section 4z - Preauthorization for Substance Abuse Treatment Not to Be Required
Section 4aa - Coverage for Medically Necessary Acute Treatment and Clinical Stabilization Services
Section 4bb - Coverage for Long-Term Antibiotic Therapy for Patients With Lyme Disease
Section 4ee - Pain Management Access Plans
Section 4ff - Coverage for Tobacco Use Cessation Counseling and Tobacco Cessation Products
Section 4hh - Coverage for Long-Term Antibiotic Therapy for Lyme Disease; Experimental Drugs
Section 4ii - Coverage for Prescription Eye Drops
Section 5 - Emergency Services Provided to Members for Emergency Medical Conditions
Section 5a - Divorced or Separated Spouses; Coverage
Section 6a - Group Health Maintenance Contracts; Contribution Percentages
Section 6b - Retroactive Claims Denials for Behavioral Health Services
Section 8 - Public Dissemination of Deceptive or Misleading Materials
Section 9 - Trade Regulation Practices; Application of Law
Section 10 - Reports; Audits, Examinations or Inspections; Confidentiality and Privilege
Section 11 - Contracts With Group Insurance Commission or Local Governments
Section 11a - Alternative Dental Coverage Option
Section 12 - Health Regulations Not Limited
Section 14 - Licensure Applicants; Documents Required; Approval by Commissioner
Section 16 - Contracts, Rates, Evidence of Coverage; Disapproval of Commissioner
Section 16a - Disapproval of Certain Health Maintenance Contracts Based on High Deductibles
Section 16b - Disapproval of Certain Health Maintenance Contracts for Coverage of Young Adults
Section 17 - Rules and Regulations; Standardized Claim Form
Section 17a - Open Enrollment for Nongroup Medicare Beneficiaries; Period, Notice of Termination
Section 19 - Discrimination Against Abuse Victims in Terms of Health Maintenance Contract
Section 23 - Insolvency of Health Maintenance Organization; Replacement Coverage
Section 25 - Net Worth of Health Maintenance Organization
Section 26 - Deposit Maintained With Trustee Acceptable to Commissioner
Section 27 - Merger or Acquisition of Control
Section 28 - Registration With Commissioner
Section 30 - Statement for Individuals Provided With Creditable Coverage; Reporting
Section 31 - Attribution of Members to a Primary Care Provider