2026 Reporting Form - Health Arrangements Provided by an Established Religious Organization

The purpose of this form is for health arrangements provided by an established religious organization to provide the Massachusetts Health Connector with certain information related to membership, operations, and finances. A complete and timely response to this form satisfies one of the criteria for a health arrangement provided by an established religious organization to be deemed to provide minimum creditable coverage (“MCC", 956 CMR 5.03(3)(d)6). The Health Connector may—after review of this form and any attendant submissions—require additional information or clarifications regarding a health arrangement’s membership, operations, and finances.

This version of the form is specific to calendar year 2026 (the “MCC Reporting Year”). Established religious entities seeking to meet the MCC reporting requirement for this MCC Reporting Year should complete this form no later than April 30, 2026. Unless otherwise noted, responses should include aggregate data from 2025, the calendar year prior to the MCC Reporting Year. Questions about this form may be directed to MCC.Certification@mass.gov.