Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 43.00 - Health Maintenance Organizations (HMOs)
Section 43.10 - Books and Records
Current through Register 1531, September 27, 2024
Every HMO shall keep and maintain its books of account and other records on a current basis and within Massachusetts. In addition, every HMO shall make, or cause to be made, and retain books and records which accurately reflect:
(1) The names and last known addresses of all current subscribers to the HMO;
(2) All contracts required to be submitted to the Commissioner and all other contracts entered into by the HMO;
(3) All requests made to the HMO for payment of monies for health care services, the date of such requests, and the dispositions thereof;
(4) The names and last known addresses of persons who solicit or obtain members for an HMO, including but not limited to employees, insurance producers and agents;
(5) The amount of any commissions paid to persons who obtained members for the HMO and the manner in which said commissions are determined; and
(6) the total number and disposition of malpractice claims and other claims relating to the service or care rendered by the HMO made by, or on behalf of, members of the HMO that were settled or resulted in a judgment during the year by the HMO.
Every HMO shall preserve for a period of not less than five years, the last two years of which shall be in an easily accessible place at the main offices of the HMO, the books of account and other records required under the provisions of, and for the purposes of 211 CMR 43.00. After such books and records have been preserved for two years, they may be stored subject to their availability to the Commissioner not more than five days after he or she may request them
