Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 148.00 - Registration And Reporting Requirements For Third-party Administrators › Section 148.04 - Annual Reporting Requirements

Current through Register 1525, July 5, 2024
(1) All
			 Third-party Administrators, as a condition of registration, shall submit an
			 annual report to the Division in a form approved by the Commissioner, no later
			 than April 1st of each year, for the year ended
			 December 31st immediately preceding which shall
			 include; or in the following alternative, as authorized by the Commissioner,
			 the Division may obtain certain annual reporting information regarding the
			 Third-party Administrator's Self-insured Customers from an alternate source.
Third-party Administrators may notify the Division on or before
				April 1st of any year regarding the Third-party
				Administrator's customer accounts that had fewer than 100 members who were
				Massachusetts residents as of December 31st of the
				previous year. Third-party Administrators that provide the Division with
				information regarding numbers of members in such customer accounts shall be
				exempt from reporting under 211 CMR 148.04(1) for those customer accounts for
				so long as such Massachusetts membership remains below 100 members in those
				customer accounts.
(a)
The
			 Third-party Administrator Annual Report
. The number of the
			 Third-party Administrator's Self-insured Customers as of December
			 31st;
(b) The aggregate number of subscriber
			 members enrolled in the benefit plans administered for all of the Third-party
			 Administrator's Self-insured Customers, including:
1. Number of subscriber members covered on
			 December 31st;
2. Number of subscriber member months covered
			 in prior calendar year; and
3.
			 Average number of subscriber members in prior calendar year.
(c) The aggregate number of
			 subscriber and dependent lives covered in the benefit plans administered for
			 all of the Third-party Administrator's Self-insured Customers, including:
1. Number of subscriber and dependent covered
			 lives on December 31st;
2. Number of subscriber and dependent covered
			 life member months in prior calendar year; and
3. Average number of subscriber and dependent
			 covered lives in prior calendar year.
(d) The aggregate value of direct premiums
			 earned for all of the Third-party Administrator's Self-insured
			 Customers;
(e) The aggregate value
			 of Direct Claims Incurred for all of the Third-party Administrator's
			 Self-insured Customers;
(f) The
			 aggregate Medical Loss Ratio for all of the Third-party Administrator's
			 Self-insured Customers;
(g) Net
			 income;
(h) Accumulated
			 Surplus;
(i) Accumulated
			 reserves;
(j) The percentage of the
			 Third-party Administrator's Self-insured Customers that include each of the
			 benefits mandated for health benefit plans under M.G.L. chs. 175, 176A, 176B
			 and 176G;
(k) The aggregated
			 administrative service fees paid by all of the Third-party Administrator's
			 Self-insured Customers to the Third-party Administrator; and
(l) Any other information deemed necessary by
			 the Commissioner.