Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 152.00 - Health Benefit Plans Using Limited, Regional Or Tiered Provider Networks
Section 152.03 - Limited and Regional Provider Network Plans
Universal Citation: 211 MA Code of Regs 211.152
Current through Register 1531, September 27, 2024
(1) A Carrier proposing to offer a Health Benefit Plan that uses a Limited Provider Network or a Regional Provider Network shall submit to the Division materials demonstrating that:
(a) The Carrier has notified each Provider of
its right to opt out of a new Health Benefit Plan with a Limited Provider
Network or a Regional Provider Network at least 60 days before the Carrier
submits the new plan to the Commissioner; and
(b) The Carrier maintains up to date
enrollment systems, Marketing Materials and Evidences of Coverage that identify
for all Providers, employers and Insureds the Provider Network available
through the Insured's Health Benefit Plan.
(2) A Carrier shall use defined criteria and evaluation systems that are coordinated by appropriate Carrier staff and overseen by the Carrier's medical director to develop Provider Networks to maintain Network Adequacy.
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