TO:Commercial Health Insurers, Blue Cross and Blue Shield of Massachusetts, Inc. and Health Maintenance Organizations Offering or Renewing Insured Health Products in the Merged Market in Massachusetts
FROM:Joseph G. Murphy, Commissioner of Insurance
DATE:October 6, 2011
RE:Distribution of Consumer Guide to Limited, Regional and Tiered Provider Network Plans


 

The Division of Insurance (“Division”) issues this Bulletin to provide commercial health insurers, Blue Cross and Blue Shield of Massachusetts, Inc. and Health Maintenance Organizations (“Carriers”) with the consumer guide on limited provider networks to be distributed to Massachusetts insureds when offering a limited, regional or tiered provider network plan, as required under  211 CMR 152.06(2)(b). 

Pursuant to 211 CMR 152.06(2)(b), the Commissioner will designate a guide that must be issued by any health benefit plan that uses a limited provider network, a regional provider network or a tiered provider network prior to the time a prospective individual non-employment-based subscriber is presented with an application or enrollment form or engages in any alternative or electronic enrollment process.  Carriers may use the attached guide doc format of bulletin-2011-17-guide
, entitled “Limited, Regional and Tiered Network Plans:  Choosing the Health Plan That’s Right for You,” to satisfy the requirements of 211 CMR 152.06(2)(b).  Carriers may obtain a copy of this guide doc format of bulletin-2011-17-guide
in electronic format from the Division’s Bureau of Managed Care at (617) 521-7372 or at BMCMailbox@state.ma.us.  
 

Carriers alternatively may create their own guide to meet the requirements of 211 CMR 152.06(2)(b).  If a Carrier elects to create its own guide, the content of such guide must be substantially similar to the guide provided by the Division, and the text of such guide must be in at least 10-point typeset and be presented in a clear and easily understood manner.  If a Carrier is using web-based applications, the Carrier may issue its guide electronically, provided that such guide is presented in a manner that is substantially similar to the guide provided by the Division, and that the text of such guide is in at least 10-point typeset and presented in a clear and easily understood manner.
 

Questions regarding this Bulletin may be directed to Nancy Schwartz, Director, Bureau of Managed Care at (617) 521-7347.