02-031 C.M.R. ch. 765, § 6 - CONTINGENCY PLANNING REQUIREMENTS

Within 30 days after the effective date of this Rule, carriers offering health insurance plans in this state shall provide the Superintendent with the following information.

1. The name and contact information for an officer of the company primarily responsible for public insurance emergency planning in Maine. If this contact information changes the carrier shall notify the Superintendent within 72 hours.

2. A description of health insurance coverage in force in Maine, which must be updated at least annually. Carriers shall provide updated descriptions within 72 hours after a request by the Superintendent. At a minimum, the description must include the following:

i. The number of group and blanket policy enrollees.

ii. The number of individual policy enrollees.

iii. The number of enrollees who have coverage for prescription medications.

iv. The number of enrollees who have coverage for influenza and pneumococcal vaccinations.

3. A description of the carrier's plans for assuring adequate staffing and business continuity during a public health emergency.

4. A description of the carrier's plans for working closely with state and federal regulatory and emergency agencies to respond to the needs of enrollees and the public during a public health emergency.

5. A description of the carrier's plans for providing enrollees and providers with essential information during a public health emergency.

6. A description of the carrier's assessment and planning to address increased need and decreased availability of medical supplies, prescription drugs and vaccinations during a public health emergency.

7. A description of the carrier's contingency plans for minimizing barriers for enrollees to access health care services and health insurance benefits during a public health emergency, including the carrier's own guidelines for deciding when to implement contingency plans. The plans and guidelines must be flexible and must include specific actions to assist the public in maintaining access to health care services and health insurance benefits depending on the nature, scope, and extent of the emergency. At a minimum contingency plans and guidelines must include the ability to implement the actions described in Section 5 of this Rule within 72 hours after a direction, rule, or order to do so issued pursuant to 24-A M.R.S.A. §478.

Notes

02-031 C.M.R. ch. 765, § 6