Dental Service of Mass., Inc. v. Commissioner of Revenue
Dental Service of Mass., Inc. v. Commissioner of Revenue
Opinion
*804 **304 The taxpayer, Dental Service of Massachusetts, Inc., 1 is an insurer that provides dental coverage through preferred provider arrangements (PPAs). 2 Pursuant to G. L. c. 176I, § 11, insurers operating PPAs are obligated to pay annually an excise **305 tax equal to a specified percentage "of the gross premiums received during the preceding calendar year for coverage of covered persons residing in this [C]ommonwealth" (emphasis added). The term "[c]overed person" is defined in the statute as "any policy holder or other person on whose behalf the organization is obligated to pay for or provide health care services." G. L. c. 176I, § 1.
The taxpayer and the Commissioner of Revenue (commissioner) disagree regarding whether "covered persons" may sometimes refer to the employer-organizations that contract with insurers, or instead refers only to the individuals receiving health care services (in this case, dental care). 3 That is, when an employer purchases group insurance on behalf of its employees, does the insurer owe tax on premiums paid by or on behalf of only those individuals who live in Massachusetts, as the taxpayer contends, or does the insurer owe tax on all premiums received from the Massachusetts-based employer regardless of where its individual employees reside, as the commissioner contends.
*805 We agree with the Appellate Tax Board (board), and conclude that "covered persons" as used in G. L. c. 176I, § 11, refers solely to natural persons who, as employees, receive insurance coverage for health care services under a group insurance plan, rather than employer entities. 4
Background . The statute governing PPAs, G. L. c. 176I, was enacted in 1988. St. 1988, c. 23, § 65. Chapter 176I includes an **306 assessment provision that requires "[e]very organization ... operating a [PPA] ... annually [to] pay an assessment equal to [2.28] per cent of the gross premiums received during the preceding calendar year for coverage of covered persons residing in this [C]ommonwealth." G. L. c. 176I, § 11 ( a ).
The taxpayer offers, through Massachusetts employers, dental insurance coverage to individual employees and members of their families using PPAs. Although all of the employers with which the taxpayer contracted were headquartered in Massachusetts during the period in question, some employees did not reside in the Commonwealth. The taxpayer paid the excise tax prescribed by G. L. c. 176I, § 11, on the total gross premiums received from Massachusetts employers in connection with its PPAs for the tax years 2006, 2007, and 2008. Subsequently, based on its reading of § 11, between 2010 and 2012, the taxpayer filed applications with the commissioner requesting an abatement and refund for taxes it has paid for 2006 through 2008 on premiums received from those employers for coverage of employees who lived outside of the Commonwealth during those tax years.
The commissioner denied the applications, finding that the taxes were properly assessed; the taxpayer appealed. The board ruled in favor of the taxpayer and granted abatements for the three tax years in question, concluding that the term "covered persons" as used in G. L. c. 176I, § 11, refers to the employees receiving health care coverage rather than the employer-organization with which the taxpayer contracted. The commissioner appealed from the board's decision, and we allowed his application for direct appellate review.
Discussion
. "Decisions of the board are reviewed for errors of law."
Bridgewater State Univ. Found
. v.
Assessors of Bridgewater
,
"[O]ur analysis begins with the statutory language, 'the principal source of insight into [l]egislative purpose.' "
Associated Subcontractors of Mass., Inc
. v.
University of Mass. Bldg. Auth
.,
**307
In considering the meaning of the term "covered persons" as used in the assessment provision, we look first to the definition provided in the statute. See
*806
Bulger
v.
Contributory Retirement Appeal Bd
.,
The fact that "policy holder" is coupled with "or other person" implies that both categories are intended to be persons "on whose behalf the organization [i.e., the insurer] is obligated to pay for or provide health care services." The use of the word "other" to modify "person" would not otherwise be necessary or, for that matter, make sense.
Phillips
v.
Equity Residential Mgt., L.L.C.
,
The commissioner asks us to interpret "covered persons residing in this [C]ommonwealth" in § 11 as applying to either employers or individuals, depending on who the "policy holder" is, pointing out that, in other statutes, employer-organizations as well as natural persons can be said to "reside" in a particular location. See,
*807
e.g., G. L. c. 4, § 13 (
a
) (newspaper subscribers); G. L. c. 59, § 18, Sixth & Seventh (partnerships); G. L. c. 110C, § 7 (stockholders); G. L. c. 110E, § 1 (
e
) (same) ; G. L. c. 110F, § 2 (
e
) (same). However, where the Legislature uses the word "reside" in reference to both natural persons and artificial entities, typically it includes additional terms describing how to apply the statute to the latter category. See, e.g., G. L. c. 149, § 6F ½ (
a
) (action for injunction or restraining order brought in county in which "such person, firm, corporation, or other entity resides or has its principal place of business"); G. L. c. 203A, § 1 (requiring common trust fund to be administered in accordance with written instrument filed "in the county in which such individual, corporation or association resides or has his or its principal place of business"). See also Mass. R. Civ. P. 4 (d), as amended,
It is true that use of the term throughout the chapter to refer to natural persons is not necessarily inconsistent with the commissioner's interpretation, that is, defining "covered persons" as either a policy holder entity that is not a natural person, or as a natural person, depending on the context used. Additionally, there are perhaps some strong policy reasons that favor the commissioner's interpretation.
10
However, consistent with the principles of statutory construction on which we rely in interpreting tax statutes, and which were respected by the board in this case, we construe the use of "covered persons" in § 11"strictly against the taxing authority" if the statute is ambiguous. See
Oliver
,
Furthermore, our interpretation is supported by the administration of G. L. c. 176I by the Division of Insurance (division).
11
,
12
The division likewise treats "covered persons" as meaning natural individual persons in administering reporting requirements for health benefit plans, which include PPAs. General Laws c. 176I, § 7, requires insurers operating PPAs to "file annually with the
**311
[C]ommissioner [of Insurance] ... a report covering its prior fiscal year." "The report shall include ... the number of covered persons under health benefit plans ..., which include preferred provider arrangements."
For all of these reasons, we conclude that the term "covered persons" in § 11 refers to the natural person receiving health care coverage under a PPA policy, including his or her spouse and additional dependents, not the employer-organization with whom the insurer contracts.
Decision of the Appellate Tax Board affirmed .
The taxpayer, Dental Service of Massachusetts, Inc., is an independent member of the Delta Dental Plans Association, an organization of thirty-nine independent dental companies that offers dental coverage throughout the United States.
A preferred provider arrangement is a "form of health care delivery in which payers contract with a select group of [health care service providers] to provide care for enrollees through their health insurance or health benefits plans under conditions that give the payer some control over costs" (footnote omitted). E.S. Rolph, J.P. Rich, P.B. Ginsburg, S.D. Hosek, K.M. Keenan, & G.B. Gertler, State Laws and Regulations Governing Preferred Provider Organizations 1 (Aug. 1986). The term "[p]referred provider arrangement" is defined in G. L. c. 176I, the statute at issue in this case, but the definition does not provide guidance as to the substance of the term. See G. L. c. 176I, § 1 (" 'Preferred provider arrangement,' a contract between or on behalf of an organization and a preferred provider which complies with all of the requirements of this chapter"). The statute defines "[p]referred provider" as a health care provider or group of providers "who have contracted to provide specified covered services."
The record indicates that the taxpayer contracts with Massachusetts-based employers, unions, and other Massachusetts groups to provide dental insurance for, respectively, individual employees, union members, and other group members (and their respective family members). In this opinion, solely for ease of reference, we mention only contracting employers and their employees, but all that is stated applies equally to contracting unions or other groups and their members.
We acknowledge the amicus brief submitted by the Massachusetts Association of Health Plans.
The statute defines "[h]ealth care services" as including "hospital, medical, surgical, dental, vision, and pharmaceutical services or products." G. L. c. 178I, § 1. Although this case involves dental insurance, we will refer generally to health care services throughout the rest of the opinion.
As for the argument of the Commissioner of Revenue (commissioner) that, in the group insurance context, it is the employer "on whose behalf the [insurer] is obligated to pay for ... health care services," G. L. c. 176I, § 1, it is recipients of the "services rendered or products sold by a health care provider" that the insurer typically "pays for;" there is nothing to suggest that they are made on the employer's behalf.
To bolster their arguments about the meaning of words "covered person," the parties refer to the differences between G. L. c. 176I and the Preferred Provider Arrangements Model Act (1987), drafted by the National Association of Insurance Commissioners (Model Act). The commissioner uses the fact that, in contrast to G. L. c. 176I, the definition of "covered person" in the Model Act refers only to an individual and not to a "policy holder" receiving health care services. See Model Act, supra at § 3B. Assuming that the Legislature relied on the Model Act, the argument that the Legislature added "policy holder" to the definition of "covered person" in order to expand the scope of taxable entities under § 11 is undermined by the use of the word "other" before "person" as discussed supra . See G. L. c. 176I, § 1.
General Laws c. 176I, § 1, defines "[e]mergency care" as
"services provided in or by a hospital emergency facility to a covered person after the development of a medical condition, ... manifesting itself by symptoms of sufficient severity that the absence of prompt medical attention could reasonably be expected ... to result in placing the covered person's or another person's health in serious jeopardy, serious impairment to body function, or serious dysfunction of any body organ or part ...."
Section 3 ( b ) provides, in relevant part:
"If a covered person receives emergency care and cannot reasonably reach a preferred provider, payment for care related to the emergency shall be made ... as if the covered person had been treated by a preferred provider; whenever a covered person is confronted with a need for emergency care, ... no covered person shall in any way be discouraged from using the ... medical service system, [or] the 911 telephone number, ... or be denied coverage for medical and transportation expenses incurred as a result of such use of emergency care."
For example, it may be easier to administer the statute if insurers pay the assessment on the entire gross premiums received from contracts for group insurance with Massachusetts employers and other groups, rather than identifying the portion of those premiums attributable to individuals covered by the group insurance plan that actually reside in the Commonwealth. Additionally, the commissioner's interpretation is consistent with the policy of assessing insurers for the value of the franchise-the benefit or value of being able to offer insurance in the Commonwealth.
The Division of Insurance (division) is an agency tasked with the regulation of insurance products. See generally, e.g., G. L. cc. 26, 175. The division is responsible for the administration and enforcement of G. L. c. 176I, with the exception of § 11, which is administered by the Department of Revenue. See G. L. c. 176I, §§ 8, 11.
Even though § 11 is administered by the commissioner, because "covered person" is defined for use throughout the chapter in § 1, any deference due for an interpretation of that term would be to the division's interpretation because that agency administers the rest of the chapter. See
Goldberg
v.
Board of Health of Granby
,
Reference
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- Dental Service of Massachusetts, Inc. v. Commissioner of Revenue.
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- Published