Section 26.04 - Required Disclosures of Material Information(1) It is an unfair or deceptive act in violation of M.G.L. c. 93A §2(a) for a Discount Health Plan or Discount Health Plan Organization to fail to disclose at the time of initial contact to a prospective member and in all advertisements, brochures or marketing material, the following material information: (a) that the plan is not insurance coverage and does not meet the minimum creditable coverage requirements under M.G.L. c.111M and 956 CMR 5.00;(b) for a plan offering a range of discounts, that the range of discounts for specified medical, pharmacy or ancillary services provided under the plan will vary depending upon the type of provider and the type of services received;(c) that the discount health plan does not make any payments to providers for services received;(d) that the plan member is obligated to pay for all services provided by providers that participate in the discount plan but will receive a discount on services provided by providers who have contracted with the discount health plan organization;(e) the name and contact information of the discount health plan, including mailing address, telephone number and email address, if any; and(f) a toll-free telephone number and website address for the discount health plan organization for prospective members and members to obtain additional information about and assistance on the plan and up-to-date lists of providers participating in the discount health plan. For purposes of 940 MCR 26.04(1), disclosure means in writing in a clear and conspicuous manner on the first content page of any advertisements, marketing materials or brochures made available to the public relating to a discount health plan and on any enrollment forms given to an individual. If the initial contact with a prospective member is in person or by telephone, disclosure must be made during such initial contact by means of a clear oral explanation prior to any solicitation or request for payment and followed, prior to enrollment, by written disclosure as required by this section.
(2) It is an unfair or deceptive act in violation of M.G.L. c. 93A §2(a) for a Discount Health Plan or Discount Health Plan Organization to fail to provide to:(a) each prospective member, at the time of enrollment, information that describes the terms and conditions of the discount health plan, including any limitations or restrictions on the refund of any processing fees or periodic charges associated with the discount health plan; and(b) each new member a written document that contains the specific terms and conditions of the discount health plan. For purposes of 940 CMR 26.04(2)(b), specific terms and conditions of the discount health plan include but are not limited to:
1) the discounts or range of discounts provided, expressed as a percentage or as a dollar amount;2) a current list of Providers or Provider Networks that provide discounts to members, directly or by reference to a website containing such a list;3) any fees or periodic charges associated with the discount health plan, including any limitations or restrictions on the refund of any fees or periodic charges and the mode of payment of any fees or periodic charges and procedures for changing the mode of payment; any limitations, exclusions, exceptions or waiting periods regarding the receipt of discounts under the discount health plan;4) the procedures for obtaining discounts under the discount health plan; cancellation procedures and refund requirements renewal, termination and cancellation terms and conditions;5) the procedures for filing complaints with the discount health plan organization; and6) the name and mailing address and phone number of the discount health plan organization.(c) It is an unfair or deceptive act in violation of M.G.L. c. 93A §2(a) for a discount health plan organization to fail to maintain on its website an up-to-date list of the names and addresses of the providers with which it has contracted directly or through a provider network, which website address shall be prominently displayed on all advertisements, marketing materials, brochures and discount health plan cards.