Notice of Hearing

Docket No. G2011-06

Proposed New Regulation 211 CMR 152.00 - Health Benefit Plans Using Selective, Regional or Tiered Provider Networks

Pursuant to Massachusetts General Laws Chapter 30A and the authority granted to the Commissioner of Insurance ("Commissioner") by SECTIONS 32 and 32A of Chapter 288 of the Acts of 2010, M.G.L. c. 176D, § 11, M.G.L. c. 176J, § 11, and M.G.L. c. 176O, §§ 2 and 17, a hearing will be held at the offices of the Division of Insurance, 1000 Washington Street, Boston, MA 02118-6200 on March 14, 2011 at 10:00 a.m. The purpose of this hearing is to afford all interested persons an opportunity to provide oral and/or written comment regarding the proposed adoption of new regulation 211 CMR 152.00, Health Benefit Plans Using Selective, Regional or Tiered Provider Networks. The proposed regulation establishes uniform requirements for marketing, advertising and consumer disclosures for health benefit plans using selective, regional or tiered provider networks in the Commonwealth.

Pursuant to SECTION 68 of Chapter 240 of the Acts of 2010, a small business impact statement is required to be included in this Notice of Hearing. The Division estimates that 211 CMR 152.00 Proposed (Clean) pdf format of 211_152_Clean.pdf , will be applicable to approximately 50 small businesses in the Commonwealth. This number includes all Massachusetts domestic insurance companies licensed to write health insurance (all kinds), health maintenance organizations, and Blue Cross and Blue Shield of Massachusetts, Inc. The Division estimates that the projected reporting, record keeping and administrative costs required for compliance with 211 CMR 152.00 will have an effect on small business to the extent the regulation will require health insurance carriers with selective, regional and tiered provider networks to incur administrative costs to adjust IT systems, create and revise marketing materials, issue disclosures and notices, and train employees and other sales force members on such products. Carriers also will incur continuing costs related to marketing and IT support for selective, regional and tiered network plans. The Division anticipates that the costs incurred will vary by health insurance carrier depending on such carrier's current administrative systems and the types of networks they currently offer. The Division is not aware of any conflicts between 211 CMR 152.00 and existing Division regulations or existing regulations of another agency or department of the Commonwealth. 211 CMR 152.00 is drafted in a performance standards format because the regulation establishes uniform requirements for all health benefit plans using selective, regional or tiered provider networks. The Division is not aware of whether 211 CMR 152.00 is likely to deter or encourage the formation of new businesses in the Commonwealth. The Division invites and encourages comments from small businesses in the Commonwealth concerning the final promulgation of 211 CMR 152.00, including the following: (1) whether 211 CMR 152.00 could establish less stringent compliance or reporting requirements for small businesses; (2) whether 211 CMR 152.00 could establish less stringent schedules or deadlines for compliance or reporting requirements for small businesses; (3) whether 211 CMR 152.00 could consolidate or simplify compliance or reporting requirements for small businesses; (4) whether 211 CMR 152.00 is likely to deter or encourage the formation of new businesses in the Commonwealth; and (5) what alternative regulatory methods, if any, may be used to minimize the adverse impact 211 CMR 152.00 on small businesses.

The proceedings concerning the permanent promulgation of regulation 211 CMR 152.00 shall be designated as Docket No.G2011-06. Any person who wishes to provide oral comment concerning this regulation must file a Notice of Intent to Comment with the Docket Clerk no later than March 11, 2011. Persons wishing to submit written comments may do so until the record of the hearing is closed. All submissions must be sent to the Docket Clerk, Hearings and Appeals, Division of Insurance, 1000 Washington Street, Suite 810, Boston, MA 02118-6200, or by electronic mail doidocket.mailbox@state.ma.us and must refer to Docket No.G2011-06 in the subject line. Persons who do not file a Notice of Intent to Comment will be heard after those who notify the Division in advance of the hearing.

A copy of the regulation is available from the Division and also is posted on its website at: www.mass.gov/doi.















Dated: February 15, 2011

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Joseph G. Murphy

Commissioner of Insurance