Wyoming Administrative Code
Agency 044 - Insurance Dept
Sub-Agency 0002 - General Agency, Board or Commission Rules
Chapter 65 - REGULATION GOVERNING THE SALE OF OUT-OF-STATE HEALTH INSURANCE POLICIES
Section 65-6 - Policy Requirements
Universal Citation: WY Code of Rules 65-6
Current through September 21, 2024
(a) Network Adequacy
(i) Pursuant to
W.S.
26-18-302(a)(vii), the
Wyoming insurance commissioner shall review any provider network requirements
in the out-of-state health insurance policy and may require modification of
those requirements if the policy lacks sufficient network providers in
Wyoming.
(ii) Provider networks are
sufficient so long as:
(A) The insurer
maintains a network that is sufficient in number and types of providers in
Wyoming so as to assure that all services will be accessible without
unreasonable delay as proven by submitting a network provider list to the
Wyoming Department of Insurance; and
(B) The network has at least thirty percent
(30%) of available essential community providers in the polices service area. A
network that has at least five percent (5%) of available essential community
providers in the polices service area may be considered sufficient so long as
the insurer includes as part of its application a satisfactory narrative
describing how the insurers provider network(s), as currently designed,
provides an adequate level of service for low-income and medically underserved
enrollees.
(iii) If the
insurer has insufficient number or type of participating providers to provide a
covered benefit, the insurer shall ensure that the covered person obtains the
covered benefit at no greater cost to the covered person than if the benefit
were obtained from participating providers, or shall make arrangements
acceptable to the Wyoming insurance commissioner.
(iv) The insurer shall include a provider
directory with the application form. The directory must at a minimum list
providers specialties, locations of providers, acceptance of new patient
status, the total unduplicated providers, and the total number of essential
community providers in the provider network. The Wyoming insurance commissioner
can require that more categories of disclosure be included in the provider
directory. The Wyoming insurance commissioner may terminate the insurers
ability to issue out-of-state health insurance policies in Wyoming should the
network fail to meet the network adequacy standards set forth in this
regulation.
(v) The insurer shall
give the Wyoming insurance commissioner prompt notice of a potential loss of a
material provider. Upon such notice the Wyoming insurance commissioner has the
authority to initiate an interim network adequacy review.
(vi) Should the state of Wyoming adopt
statutory standards for network adequacy for health insurance policies sold in
Wyoming, those statutory provisions will preempt this regulatory guidance on
network adequacy. Policies sold pursuant to W.S.
W.S.
26-18-301, et seq. will then be required to
meet the statutory standards for network adequacy.
Disclaimer: These regulations may not be the most recent version. Wyoming 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.
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