A. No person, partnership, carrier, or
corporation shall commence offering a preferred provider arrangement after the
effective date of this Rule, until the person, partnership, carrier or
corporation has registered with the Superintendent as required by this
B. A carrier or administrator
registering a preferred provider arrangement must complete an initial
registration on a form prescribed by the Superintendent.
C. Registrants are required to submit
information in this initial registration in compliance with M.R.S.A. Title 24-A
Chapter 56-A and Rule 850. Information previously reported to the
Superintendent pursuant to Chapter 56-A and Rule 850 must be referenced in the
registration materials and not reported in a duplicate manner.
D. Carriers that offer plans in different
geographic service areas or having preferred providers in one plan who are
nonpreferred providers in another plan offered by the same carrier must
separately file and obtain approval for each arrangement. Plans that offer
multi-tier preference tiers for preferred providers must also be registered as
separate provider arrangements.
Preferred provider administrators who directly or indirectly transfer funds,
manage funds, adjust claims, or assert control over the transfer of funds for
the purpose of payment of provider services are required to be licensed as
insurance administrators pursuant to Chapter 18, in addition to registering as
a preferred provider arrangement.
F. Each registered carrier and administrator
must keep current the information required to be disclosed in its registration
statement by reporting all material changes or additions to the Superintendent
within 30 days after the end of the month during which the material event