I was a member of MassHealth. They canceled my insurance without notice. They denied my renewal because I have a job. Can they do that? I have ADHD, depression, compulsive eating disorder and other disabilities.

S.W.

An overlapping system of state and federal laws and regulations governs the renewal of health insurance. With very few exceptions, companies cannot cancel health insurance sold in the group or non-group market. One exception is failure to pay the required premium. Another is fraud or misrepresentation. Those are fairly obvious. There are other exceptions to the prohibition on cancellation that may require a little explanation.
First, an insurance company may find that it is losing so much money in a state that it decides to terminate all its health insurance in that state. This is a drastic step for a company, and the decision to do so does not come easily. Often, a company will try to save the business and protect the policyholders by selling the failing blocks of business to a company that has been more successful. If the company cannot accomplish this, it must contact the insurance department to inform officials of the intent to terminate all its business in the state. The insurance department works with the company to try to find an alternative to cancellation. When all avenues of remedy are exhausted, only then will the insurance department allow the company to pull out of the state. But there is one more hurdle; the insurance company must give six to 12 months of notice to all policyholders before taking this action. And that is only one of several notices insurance companies must give policyholders. There is a whole host of notification requirements applied to this and other situations.

Second, the law allows termination of insurance coverage for a particular policyholder if the person is no longer eligible for the coverage, but only after notice is given. Some health plans state by law that if the person is eligible for coverage under a group plan provided by the employer or the spouse's employer, then the person is no longer eligible for his or her current coverage. Again, however, the insurance company would have to give you notice of the impending action.

Your coverage was through MassHealth: a state-sponsored, comprehensive health insurance and premium assistance program for parents, children, senior citizens and persons who are disabled or unemployed. This public assistance program has its own set of eligibility rules, including income levels and employment status. MassHealth can terminate your coverage if you are no longer eligible due to your employment. If you have any questions about the manner in which your coverage was terminated, call 1-800-841-2900 for more information.

Even though your coverage was terminated, you may have other opportunities for insurance. In Massachusetts, all residents are guaranteed insurance, regardless of their health status. If your new employer does not provide insurance and you cannot afford the premiums for non-group insurance, MassHealth may provide some assistance. You can apply for coverage each year during an annual two-month open enrollment period. You may also obtain coverage at other times throughout the year if you apply within 30 days of an event which makes you newly eligible for the coverage, and, in some cases, within 63 days of a termination of previous coverage. You should contact the Division of Insurance at 617-521-7777 to find out if the 63-day enrollment period applies to you.

The Insurance Division can also provide information on insurance carriers. For a complete description of insurance options for consumers in the non-group market, go to the Insurance Division's website and click on "Consumer Information Guide: Nongroup Health Insurance Plans in Massachusetts."