The SRB reviews life, health (including Medicare Supplement), property, liability insurance policies and rates, as well as health maintenance organizations and preferred provider arrangement applications for compliance with applicable laws and regulations. The SRB collects and analyzes statistical data in order to provide technical advice to the Commissioner on oversight of the auto, workers' compensation, health and other insurance markets.
Bureau of Managed Care
One unit of the SRB -- the Bureau of Managed Care -- annually accredits carriers offering managed care plans in Massachusetts and ensures compliance with the requirements of Chapter 176O and regulation 211 CMR 52.00 . The Bureau establishes minimum standards for: utilization review; quality management and improvement; credentialing; preventive health services; provider contracts; and consumer disclosures. The Bureau also investigates complaints against carriers for noncompliance with accreditation requirements.
Health Care Access Bureau
Created as part of the health care reform legislation of 2006, the Health Care Access Bureau is responsible for regulatory oversight of the small group and individual health insurance markets, and of affordable health plans. The Bureau disseminates information to consumers relative to health insurance coverage and, specifically, access to affordable insurance products.
Policy Forms Review
Insurance contracts, forms and rates are reviewed for compliance with Massachusetts laws by the Policy Forms Review Section. This analysis includes determining whether the benefits to be provided are reasonable in relation to the premiums charged. Additionally, policy provisions are reviewed to determine that they are not misleading, deceptive or not in the public interest. Rate adjustments are evaluated based on whether the proposed rates are reasonable, adequate, not excessive, nor unfairly discriminatory.