Health Insurance Products and Plans
Here find filing guidelines for Health Maintenance Organizations (HMOS), membership and utilization reports and a list of accredited health insurance carriers in Massachusetts.
Group Products and Plans
HMO Guidelines For Reporting Membership & Utilization
Guidelines that each HMO utilizes in reporting quarterly membership after the close of each calendar quarter and semi-annual utilization statistics
- HMO Membership Reports
Consistent with 211 CMR 43.05(2) , the Division requests that each health maintenance organization (HMO) file detailed utilization information on a semi-annual basis.
The following reports summarize the utilization information as reported by each HMO- Insured Preferred Provider Membership
- Individual/Small Group Membership
- Non-Group Membership
- Medicare Supplement Membership
- Accredited Carriers
Annual Reports
The Division prepares annual reports pursuant to M.G.L Chapter 175 § 17.
Financial Examination Reports
Insurance companies are statutorily required to undergo comprehensive financial examinations every five years. Financial examiners from the Division of Insurance provide on-site accounting and auditing of the financial conditions of companies. Upon completing an exam, a report is issued.
Market Conduct Reports
The Market Conduct Unit performs examinations and market analysis reviews of insurance carriers to ensure the fair treatment of policyholders. These reviews often involve several states and result in fines or consumer restitution.
Medical Malpractice Insurance Reports
The DOI periodically produces on medical malpractice insurance. This report is prepared voluntarily by the DOI and is not required by statute.
Insurance Third Party Administrator Reports
Third-party Administrators (TPAs) self-report to the Division of Insurance information on the self-funded health plans they administer for employers and unions.
Credit Insurance Reports
As required by M.G.L. c. 175, §117C(b), the Division of Insurance (“DOI”) collects information from all carriers with credit insurance experience.
Transportation Network Vehicle Insurance Reports
State law, M.G.L. c. 175, § 228(i), requires the Division of Insurance to produce an annual report concerning the minimum insurance coverage required for transportation network vehicles.