Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 121.00 - Procedures Concerning Rate Filings Made Pursuant To M.g.l. C. 176k, And The Conduct Of Hearings On Such Filings
Section 121.01 - Definitions

As used in 211 CMR 121.00, the following words shall mean:

Amended Filing. A Rate Filing that the Presiding Officer, in his or her discretion, has permitted to be amended.

Commissioner. The Commissioner of Insurance appointed pursuant to M.G.L. c. 26, § 6, or his or her designee.

Division. The Division of Insurance established pursuant to M.G.L. c. 26, § 1.

Docket Clerk. The person who controls and maintains the docket files that contain the records of Hearings held at the Division.

Filer. An Issuer or a Health Maintenance Organization that files a Rate Filing in accordance with the provisions of M.G.L. c. 176K.

Hearing. The part of a Proceeding in which sworn testimony, oral and written, and Papers and other documentary evidence are submitted for consideration by the Commissioner.

Information Request. A written request to a Party for production of documents or tangible things.

Intervenor. A person, agency or organization likely to be substantially and specifically affected by a Rate Filing that is granted Intervenor status pursuant to conditions established by the Presiding Officer.

Issuer. A company, as defined in M.G.L. c. 175, § 1, that is authorized to write accident and health insurance; a hospital service corporation as defined in M.G.L. c. 176A, § 1; a medical service corporation as defined in M.G.L. c. 176B, § 1; a Fraternal Benefit Society, authorized under M.G.L. c. 176; or a Health Maintenance Organization licensed under M.G.L. c. 176G; that in the Commonwealth offers, sells, delivers or otherwise makes effective, or renews in Massachusetts Medicare Supplement Insurance Policies. For purposes of determining whether an Issuer is offering a non-network Medicare Supplement plan, an Issuer shall include the Issuer, its parent company or companies, its affiliated companies, and/or its subsidiary companies.

Medicare. "Health Insurance for the Aged Act," Title XVIII of the Social Security Act Amendments of 1965.

Medicare Supplement Insurance or Policy. A type of health insurance issued by a carrier, other than a policy issued pursuant to a contract under Section 1876 or Section 1833 of the federal Social Security Act ( 42 U.S.C. Section 1395 et seq.), or a policy issued under a demonstration project authorized pursuant to amendments to the federal Social Security Act, which is advertised, marketed or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical or surgical expenses of persons eligible for Medicare. Unless specified otherwise, references in 211 CMR 121.00 to Medicare Supplement Insurance or Policy are intended to refer collectively to Medicare Supplement Insurance or Policy and Medicare Select Insurance or Policy.

Medicare Select Insurance or Policy. A Medicare Supplement Insurance or Policy that contains Restricted Network Provisions. Unless specified otherwise, references in 211 CMR 121.00 to Medicare Supplement Insurance or Policy are intended to refer collectively to Medicare Supplement Insurance or Policy and Medicare Select Insurance or Policy.

Papers. All written documents filed in a proceeding, including Rate Filings, Responsive Filings, motions, pleadings, briefs, memoranda and other communications.

Participant. A person, agency, or organization that is granted permission to participate in a Proceeding on a limited basis as determined by the Presiding Officer.

Party. A Filer, the State Rating Bureau, a Statutory Intervenor, or an Intervenor.

Policy. Any Policy, Certificate, contract, agreement, statement of coverage, rider or endorsement issued by an Issuer as defined herein which provides Medicare Supplement Insurance as defined herein other than a policy issued pursuant to a contract under Section 1876 of the federal Social Security Act ( 42 U.S.C. Section 1395 et seq.) or an issued policy under a demonstration project specified in 42 U.S.C. § 1395ss(g)(1), which provides Medicare Supplement Insurance as defined herein. The term "Policy," unless stated otherwise within 211 CMR 71.00: Medicare Supplement Insurance to Facilitate the Implementation of M.G.L. c. 176K and Section 1882 of the Federal Social Security Act, includes any Alternate Innovative Benefits Riders. Policy does not include Medicare Advantage plans established under Medicare Part C, Outpatient Prescription Drug plans established under Medicare Part D, or any Health Care Prepayment Plan (HCPP) that provides benefits pursuant to an agreement under § 1833(a)(1)(A) of the Social Security Act.

Presiding Officer. The Commissioner or a person or persons designated by the Commissioner to conduct Proceedings pursuant to 211 CMR 121.00.

Proceeding. The public hearing process under M.G.L. c. 176K, § 7(g), by which the Commissioner reviews and addresses a Rate Filing.

Public Comment Hearing. The part of a Proceeding in which persons are given an opportunity to make oral statements about a Rate Filing. Written statements may be submitted at a Public Comment Hearing or at any time prior to the closing of the Proceeding.

Rate Filing or Filing. Documents filed with the Commissioner by a Filer pursuant to M.G.L. c. 176K.

Record Request. A request for production of documents or tangible things made to a Party during a Proceeding.

Responsive Filing. Any recommendations, including supporting information or commentary, concerning a Rate Filing, or any portion thereof, filed in accordance with 211 CMR 121.09.

Revised Rate Filing. A Rate Filing that has been revised to respond to the issues that resulted in disapproval of a Rate Filing.

State Rating Bureau. The rating bureau in the Division established pursuant to M.G.L. c. 26, § 8E.

Statutory Intervenor. A person, agency or organization, including, but not limited to, the Attorney General, that has a statutory right to appear as an Intervenor in a Proceeding.

Technical Conference. A conference convened by the Presiding Officer to enable the Parties to narrow the issues in dispute. A Technical Conference may involve examination and cross-examination of sworn witnesses in order to clarify the technical aspects of a Rate Filing. Topics of such inquiry may include the data relied upon by the Filer, the projection trends selected, and applicable federal law.