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 152.09 - Plan Reporting for Limited, Regional and Tiered Provider Network Plans

Universal Citation: 211 MA Code of Regs 211.152

Current through Register 1531, September 27, 2024

Carriers shall submit to the Division by April 30th of each year information identifying the prior year's utilization trends of employers and individuals enrolled in the Carrier's Limited Provider Network plans and Tiered Provider Network plans. The information shall be submitted in a format and according to specifications identified by the Commissioner, which shall include, but shall not be limited to:

(a) The number of Insureds enrolled by plan type;

(b) Aggregate demographic and geographic information on all Insureds;

(c) Direct premium claims incurred as defined in M.G.L. c. 176J, § 6 for the Carrier's Limited Provider Network plans and Tiered Provider Network plans as compared to direct premium claims incurred for the Carrier's non-tiered and non-Limited plans;

(d) Utilization by tier during the plan year; and

(e) Requests by Insureds enrolled in Limited Provider Network plans for out-of-network coverage within the plan year.

Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.