Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 153.00 - Continuity Of Care Access To Comprehensive Cancer Centers, Pediatric Hospitals, And Pediatric Specialty Units For Small Group Health Benefit Plans That Utilize Limited, Regional Or Tiered Provider Networks
Section 153.03 - Notice to Insureds in Limited, Regional and Tiered Provider Network Plans Offered to Eligible Small Businesses or Eligible Individuals
Current through Register 1531, September 27, 2024
A Carrier with a Health Benefit Plan offered to Eligible Small Businesses or Eligible Individuals that utilizes a Limited, Regional or Tiered Provider Network shall issue and deliver a notice relating to access to continuity of care, separate from the evidence of coverage for said plan. The Carrier shall post said notice prominently on its website and shall issue and deliver said notice to each member household on or before June 15, 2012, and, thereafter, to all newly Insured member households prior to the effective date of coverage. Such notice shall describe:
(1) the Insured's rights to continuity of care access under 211 CMR 153.04;
(2) the process by which the Insured and the Insured's provider may pursue access to continuity of care at a Comprehensive Cancer Center, a Pediatric Hospital, or a Pediatric Specialty Unit under 211 CMR 153.04;
(3) the importance of the Insured or the Insured's provider informing the Carrier that continuity of care access is being sought prior to the Insured's receipt of any covered Health Care Services that are subject to a continuity of care access determination under 211 CMR 153.04; and
(4) the Insured's possible liability for charges if continuity of care is accessed in violation of 211 CMR 153.04.
