State RegulationsMA specificDifficulty 2/5
A Massachusetts resident with a significant preexisting medical condition applies for an individual health plan. Under the guaranteed-issue rules Massachusetts applies in coordination with the Affordable Care Act framework, what must the carrier do?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Guaranteed issue is the operative rule: Massachusetts law, implemented through the small-employer and individual framework of M.G.L. c. 176J and administered alongside the Massachusetts Health Connector, requires carriers to issue coverage without regard to health status, and the individual market mirrors the small-group offerings. A preexisting condition may affect nothing about the decision to issue — the carrier cannot deny, condition, or medically underwrite the application on health grounds.
Why the other options are wrong
- B) There is no requirement to divert the applicant to a separate program first; guaranteed issue under M.G.L. c. 176J means the carrier itself must issue.
- C) Conditioning the issuance on an exclusion for the known condition defeats guaranteed issue; the health status may not be used against the applicant.
- D) Health-based premium loading is precisely what guaranteed issue forbids; the Massachusetts rules bar using the condition to price or condition the coverage.
Memory hook
Health status can't say no — Massachusetts guarantees the issue.