02-031 C.M.R. ch. 360, § 4 - Registration of a preferred provider arrangement

Current through 2022-14, April 6, 2022

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 Rule.

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.

E. 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 occurs.

Notes

02-031 C.M.R. ch. 360, § 4