WeVote
Log In

Bill

Bill

H 4937

An Act providing for certain health insurance coverage

194th Legislature (2025-2026) Introduced by Sean Garballey and 1 co-sponsor

The bill aims to clarify and expand mandated health insurance coverages in Massachusetts for insured individuals and insurers.

Reporting date extended to Thursday, December 31, 2026
0
WeVote Research Nonpartisan
Bill Summary · H 4937

Overview

House Bill H.4937 of the 194th Massachusetts Legislature, titled An Act providing for certain health insurance coverage, proposes changes to health insurance requirements and coverage standards. The bill is in the committee process, with reported favorable action from the Financial Services Committee and referral to the Health Care Financing Committee. A reporting date extension was noted to December 31, 2026.

Purpose and intent

  • To specify and expand health insurance coverage requirements within Massachusetts.
  • Aims to clarify coverage standards and ensure certain services or protections are available to insured individuals, potentially addressing gaps in coverage or access.

Key provisions and changes (as inferred from committee actions and title)

  • The bill likely updates or adds coverage mandates under private health insurance, possibly including:
    • Expanded coverage for specific medical services, tests, or treatments.
    • Clarifications on coverage limitations, prior authorization, or confirmation of benefits.
    • Consumer protections related to plan design, cost-sharing, or notice requirements.
  • Given its title, it focuses on ensuring certain health insurance coverages are provided or explicitly required by insurers operating in Massachusetts.

Note: The exact statutory text is not provided here. The summary reflects typical contents of an act with this title and the legislative actions noted (favorably reported by Financial Services and referred to Health Care Financing).

Who is affected

  • Individuals enrolled in health insurance plans regulated or offered in Massachusetts.
  • Employers and insurers in the Massachusetts market, who would need to ensure compliance with any new or clarified coverage requirements.
  • Healthcare providers may experience changes in claims processing or prior authorization procedures if new coverage rules affect reimbursement.

Procedural and timeline aspects

  • January 22, 2026: Reported favorably by the Committee on Financial Services; new draft referenced (H1165) and referred to the Committee on Health Care Financing.
  • January 22, 2026: Indicated as a favorable report and referral move within committee workflow.
  • July 9, 2026: Reporting date extension announced, extending the timeframe to Thursday, December 31, 2026, for reporting on the bill.
  • As with many Massachusetts bills, final status depends on subsequent committee reports, potential amendments, and both chambers (House and Senate) floor votes, followed by a governor’s signature or veto actions.

Potential impacts and considerations

  • Access to care: If the bill expands or clarifies coverage, it could improve patient access to specified services without increased out-of-pocket costs.
  • Consumer protections: Possible enhancements to transparency around benefits, exclusions, and claims processes.
  • Administrative compliance: Insurers may need to adjust plan documents, filing materials, and IT systems to reflect new coverage requirements.
  • Budgetary implications: Depending on the services affected and the scope of expansion, there could be cost implications for state-regulated health plans and potentially subsidies or premium impacts.

Summary

H.4937 seeks to provide for certain health insurance coverage within Massachusetts, with the objective of clarifying and potentially expanding mandated coverages. The bill is currently moving through committee stages, with a favorable report from Financial Services and continued consideration by Health Care Financing. A late-2026 reporting deadline has been established, signaling ongoing attention to its provisions and potential impacts on insured individuals, employers, and insurers in the commonwealth.

Compiled from official sources — confirm details with the bill’s official record.

Sign in to ask a question.