211 CMR 148.04 - Annual Reporting Requirements

(1) All Third-party Administrators, as a condition of registration, shall submit an annual report to the Division in a form approved by the Commissioner, no later than April 1^st of each year, for the year ended December 31^st immediately preceding which shall include; or in the following alternative, as authorized by the Commissioner, the Division may obtain certain annual reporting information regarding the Third-party Administrator's Self-insured Customers from an alternate source.

Third-party Administrators may notify the Division on or before April 1^st of any year regarding the Third-party Administrator's customer accounts that had fewer than 100 members who were Massachusetts residents as of December 31^st of the previous year. Third-party Administrators that provide the Division with information regarding numbers of members in such customer accounts shall be exempt from reporting under 211 CMR 148.04(1) for those customer accounts for so long as such Massachusetts membership remains below 100 members in those customer accounts.

(a) The Third-party Administrator Annual Report. The number of the Third-party Administrator's Self-insured Customers as of December 31^st;

(b) The aggregate number of subscriber members enrolled in the benefit plans administered for all of the Third-party Administrator's Self-insured Customers, including:

1. Number of subscriber members covered on December 31^st;

2. Number of subscriber member months covered in prior calendar year; and

3. Average number of subscriber members in prior calendar year.

(c) The aggregate number of subscriber and dependent lives covered in the benefit plans administered for all of the Third-party Administrator's Self-insured Customers, including:

1. Number of subscriber and dependent covered lives on December 31^st;

2. Number of subscriber and dependent covered life member months in prior calendar year; and

3. Average number of subscriber and dependent covered lives in prior calendar year.

(d) The aggregate value of direct premiums earned for all of the Third-party Administrator's Self-insured Customers;

(e) The aggregate value of Direct Claims Incurred for all of the Third-party Administrator's Self-insured Customers;

(f) The aggregate Medical Loss Ratio for all of the Third-party Administrator's Self-insured Customers;

(g) Net income;

(h) Accumulated Surplus;

(i) Accumulated reserves;

(j) The percentage of the Third-party Administrator's Self-insured Customers that include each of the benefits mandated for health benefit plans under M.G.L. chs. 175, 176A, 176B and 176G;

(k) The aggregated administrative service fees paid by all of the Third-party Administrator's Self-insured Customers to the Third-party Administrator; and

(l) Any other information deemed necessary by the Commissioner.

(2) Annual reports submitted by Third-party Administrators shall be certified by at least two officers of the Third-party Administrator.

(3) All information submitted to the Division in the annual report shall be a public record.

(4) If a Third-party Administrator contracts with another Third-party Administrator to provide services on behalf of a Self-insured Customer, such information shall be included in the annual report for Third-party Administrator that contracts with the Self-insured Customer.

(5) If a Third-party Administrator is unable to provide any of the required information set forth in 211 CMR 148.04 in the annual report and the Commissioner has not authorized the Division to obtain the information from an alternate source, the Third-party Administrator shall provide a detailed explanation, within the annual report, of the reason(s) that such required information is not available.

(6) Any Third-party Administrator which is required to submit an annual report and which fails to submit the annual report to the Division in the form and within the time provided shall be subject to a late penalty of not more than $100 per day.

(7) Any Third-party Administrator which also is a Health Insurer that is required to submit an Annual Comprehensive Financial Statement to the Division in accordance with M.G.L. c. 176O, § 21(a) and 211 CMR 149.00: Annual Comprehensive Financial Statements Pursuant to M.G.L. c. 176O, § 21 shall be exempt from the annual reporting requirements set forth in 211 CMR 148.04.

(8) Any Third-party Administrator which receives or collects charges, contributions or premiums for, or adjusts or settles claims on or for residents of the Commonwealth on behalf of a Health Insurer that itself is required to submit an Annual Comprehensive Financial Statement to the Division in accordance with M.G.L. c. 176O, § 21(a) and 211 CMR 149.00: Annual Comprehensive Financial Statements Pursuant to M.G.L. c. 176O, § 21 shall be exempt from the annual reporting requirements set forth in 211 CMR 148.04 for those services that the Third-party Administrator provides on behalf of the Health Insurer.

Notes

211 CMR 148.04

Amended by Mass Register Issue 1351, eff. 11/3/2017.