211 CMR 66.12 - Health Plan Filing and Reporting Requirements

Current through Register 1466, April 1, 2022

(1) Carriers must file all Health Benefit Plans offered under 211 CMR 66.00 with the Division. A Carrier that may require Eligible Small Groups with five or fewer Eligible Employees and/or Eligible Individuals to obtain coverage through an Intermediary, shall file a list of those Intermediaries, with associated contact information as further provided in 211 CMR 66.12(3), prior to requiring those small groups or individuals to go through an Intermediary to obtain small group health coverage.

(2) Carrier Reporting Requirements. On or before March 31^st, the Division will collect a report from each Carrier that contains at least the following information in a format specified by the Commissioner:

(a) Total number of Health Benefit Plans subject to M.G.L. c. 176J offered in Massachusetts during the preceding calendar year;

(b) Total number of lives covered under Health Benefit Plans subject to M.G.L. c. 176J offered in Massachusetts, as of the close of the preceding calendar year;

(c) Number of Eligible Individuals and their Eligible Dependents covered under Health Benefit Plans subject to M.G.L. c. 176J offered in Massachusetts, as of the close of the preceding calendar year;

(d) Number of Eligible Employees and their Eligible Dependents covered under Health Benefit Plans subject to M.G.L. c. 176J offered in Massachusetts, as of the close of the preceding calendar year;

(e) Number of Eligible Employees and their eligible dependents covered under Health Benefit Plans subject to M.G.L. c. 176J with limited or no mandated benefits offered in Massachusetts, as of the close of the preceding calendar year;

(f) A statement as to whether a Carrier requires individuals and/or groups of five or fewer Eligible Employees to enroll through an Intermediary or through the Connector. If the Carrier requires individuals and/or groups of five or fewer eligible employees to enroll through an Intermediary the report must also contain:

1. The name, address and phone number of the Intermediary; and

2. The Intermediary's membership requirements, including any fees paid by members to join or maintain membership in the Intermediary.

(3) Intermediary Requirements.

(a) Initial Filing. Prior to enrolling Eligible Small Businesses or Eligible Individuals within a Health Benefit Plan, an Intermediary is to file with the Commissioner a report that contains at least the following information certified by an officer of the organization in a format specified by the commissioner:

1. A narrative description of the Intermediary;

2. A copy of the basic organizational documents of the Intermediary, such as the articles of incorporation, and amendments thereto;

3. A copy of the bylaws, rules, regulations or other similar documents regulating the conduct of the internal affairs of the Intermediary;

4. A copy of the eligibility criteria for individuals or groups seeking to join the Intermediary, including, but not limited to, the forms that individuals or Members must complete prior to enrollment in the Intermediary;

5. The number of Massachusetts Members in the Intermediary who buy health insurance through the Intermediary, broken out by eligible groups and Eligible Individuals;

6. A listing of the services, other than health insurance, which the Intermediary offers to its members;

7. The fees paid by members to join or maintain membership in the Intermediary;

8. A description of each Health Benefit Plan offered by the Intermediary to the Intermediary's members who are Residents of Massachusetts;

9. A statement declaring that the Intermediary does not condition enrollment in a Health Benefit Plan on health status, claims experience, Wellness Program usage, tobacco usage, or duration of coverage since issue; and

10. A statement affirming that the Intermediary was not formed for the purposes of obtaining insurance.

(b) Annual Filing. Every Intermediary which has met the filing requirements of 211 CMR 66.12(3)(a) must, on or before April 1^st of each year, file a report that contains at least the following information, in a format specified by the Commissioner:

1. The number of Massachusetts Members in the organization who buy health insurance through the Intermediary, broken out by eligible groups and Eligible Individuals;

2. A listing of the services, other than health insurance, which the Intermediary offers to its members;

3. The fees paid by members to join or maintain membership in the Intermediary;

4. A description of each Health Benefit Plan offered by the Intermediary to its members who are Residents of Massachusetts;

5. A statement describing whether the Intermediary conditions Health Benefit Plan coverage on health status, claims experience, or duration of coverage since issue; and

6. A statement affirming that the Intermediary was not formed for the purposes of obtaining insurance.

(c) Material Changes. Every Intermediary must file with the Commissioner any material changes to the information on file within 30 days of the changes. Such material changes must be on a statement certified by an officer of the organization.

Notes

211 CMR 66.12

Amended by Mass Register Issue 1349, eff. 10/6/2017.