Bill
S 803
Mandates annual executive physical exam coverage for MA residents via GIC, MassHealth, and private plans, with separate inpatient reimbursement, for policies issued after 9/1/2026.
Status and filing
- Bill number: S 803
- Filed in Senate docket: 1/16/2025; Presented by Patrick M. O’Connor (First Plymouth and Norfolk).
- Legislative actions reported: Passed Senate (1/22/2025), Passed House/Returned to Senate (2/05/2025), Delivered to Governor (2/12/2025), Signed into law as Chapter 90 (2/14/2025).
- Effective for insurance policies/contracts: those delivered, issued or renewed on or after September 1, 2026.
Note on sponsor list: the set of federal U.S. Senators listed in the provided metadata appears inconsistent with the Massachusetts state bill record; the bill text and primary legislative sponsor in the Massachusetts General Court is Patrick M. O’Connor.
Purpose
- Require broad health insurance coverage for an annual “executive physical examination” so that insured Massachusetts residents and certain beneficiaries (including state employees and Medicaid managed care enrollees) have access to this preventive service.
Key provisions
- Adds mandatory coverage for an annual executive physical examination across multiple parts of Massachusetts law, by inserting new sections into:
- Chapter 32A (Group Insurance Commission — applies to active/retired Commonwealth employees insured under the GIC);
- Chapter 118E (MassHealth/Medicaid managed care contractors and related vendors);
- Chapter 175 (individual and group accident and sickness insurance);
- Chapter 176A (hospital service plans);
- Chapter 176B (medical service agreements);
- Chapter 176G (health maintenance organizations).
- Requires that if the executive physical is provided in an inpatient setting, reimbursement for that exam be paid separately from existing hospital inpatient payments (i.e., a distinct reimbursement rather than folded into DRG/hospital payment).
- Coverage requirements apply to policies/contracts delivered, issued, or renewed on or after September 1, 2026.
Who is affected
- Beneficiaries:
- Active and retired Commonwealth employees insured through the Group Insurance Commission;
- MassHealth/Medicaid managed care enrollees whose plans/contracts are subject to Chapter 118E;
- Residents and employees of Massachusetts covered by individual or group accident & sickness policies, HMOs, hospital service plans, and medical service agreements.
- Payers/providers:
- Private insurers, HMOs, health plans, third‑party administrators, behavioral health managers and contracted entities under Medicaid managed care;
- Hospitals and inpatient facilities (because of separate reimbursement requirement).
- Employers and plan sponsors (for group coverage) may be affected via plan design and premium impacts.
Other notable points and potential impacts
- The bill text does not define “executive physical examination.” Implementation will likely require carrier/agency guidance or regulation to specify covered services, frequency, site‑of‑service rules, prior authorization, and billing codes.
- Mandating separate inpatient reimbursement could change billing/payment practices and hospital negotiations; it may also affect premium costs or Medicaid rates.
- The effective-date carveout (applies to policies issued/renewed on/after 9/1/2026) delays operational impact until plan renewal cycles after that date.
Procedural/timeline summary
- Law became Chapter 90 following governor’s signature in February 2025; coverage and contract changes required beginning with policies delivered/issued/renewed on or after September 1, 2026. Regulators and payers will need to prepare plan language, billing guidance, and possibly regulatory clarifications before that date.
Compiled from official sources — confirm details with the bill’s official record.
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