211 CMR 152.08 - Provider Directories for Limited, Regional and Tiered Provider Network Plans

Current through Register 1466, April 1, 2022

(1) In addition to containing the information required under 211 CMR 52.15, the first or cover page of a printed provider directory or the first screen of an internet-based provider search tool for a Health Benefit Plan that uses a Limited Provider Network, a Regional Provider Network or a Tiered Provider Network shall include a statement prominently displayed in a clear and conspicuous manner that is substantially similar to the following:
(a) Limited/Regional Provider Network. This plan provides access to a network that is smaller than [name of carrier]'s [general provider network name] provider network. In this plan, members have access to network benefits only from the providers in [name of network]. Please consult the [Limited/Regional] provider directory or visit the provider search tool at [web address] to determine which providers are included in the [name of network]."
(b) Tiered Provider Network. This plan includes the tiered provider network called [name of network]. In this plan, members pay different levels of [copayments, coinsurance, deductibles] depending on the tier of the provider delivering a covered service or supply. This plan may make changes to a provider's benefit tier annually on [identify date]. Please consult the [name of network] provider directory or visit the provider search tool at [web address] to determine the tier of providers in [name of network].
(2) For Health Benefit Plans using Tiered Provider Networks, a symbol shall be displayed next to each Provider listing that prominently identifies the exact tier that the Provider is assigned to in the Provider Network.
(3) For Health Benefit Plans using Tiered Provider Networks, there shall be a note at the bottom of each printed page, or in the case of an internet webpage, at the bottom of each screen print, notifying the reader of the next date on which the Carrier may update the classification of Providers among the benefit tiers.


211 CMR 152.08

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