Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 151.00 - Certified Group Purchasing Cooperatives › Section 151.09 - Review of Application to be Certified Group Purchasing Cooperative

Current through Register 1525, July 5, 2024
(1) The Commissioner shall review complete
			 applications to be a certified Group Purchasing Cooperative only if fewer than
			 six Group Purchasing Cooperatives are then so certified and if there are fewer
			 than 85,000 Insureds participating in such certified Group Purchasing
			 Cooperatives. If fewer than six Group Purchasing Cooperatives are so certified
			 and if there are fewer than 85,000 Insureds participating in such certified
			 Group Purchasing Cooperatives, then the Commissioner shall provide notice that
			 applications to be a certified Group Purchasing Cooperative will be reviewed,
			 if such applications are submitted to the Division during the time period
			 established by the Commissioner.
(2) If, at any time, the number of applicants
			 to be a certified Group Purchasing Cooperative exceeds the six Group Purchasing
			 Cooperatives permitted by M.G.L. c. 176J, § 12(b), the Commissioner will
			 consider which of the applicants better satisfies the criteria set forth in
			 211 CMR 151.00 and provides
			 access to Group Purchasing Cooperative Health Benefit Plans in a geographic
			 area or to a type of small business or to a type of Association not currently
			 served by other certified Group Purchasing Cooperatives.
(3) Upon receipt of a complete application to
			 be a certified Group Purchasing Cooperative, the Commissioner shall review the
			 submitted materials to determine whether the applicant meets the following
			 requirements:
(a) The applicant has a
			 corporate and organizational structure capable of supporting the Covered
			 Benefits to be offered;
(b) The
			 applicant has a business plan to administer the Group Purchasing Cooperative
			 and its Wellness Program(s) such that the Group Purchasing Cooperative's Health
			 Benefit Plans and Wellness Programs are available and accessible to Insureds
			 and ensure at all times that at least 33% of covered members are enrolled in
			 Wellness Programs;
(c) The
			 applicant has enrollment systems that:
1.
			 Ensure that no Qualified Associations, Eligible Association Members, Eligible
			 Small Businesses, Eligible Employees or Eligible Dependents are denied or
			 non-renewed coverage due to health condition, age, race or sex, and ensure that
			 Health Benefit Plans are not made available to other than Eligible Association
			 Members, Eligible Small Businesses, Eligible Employees and Eligible
			 Dependents;
2. Ensure that those
			 Eligible Small Businesses that purchase Health Benefit Plans through the Group
			 Purchasing Cooperative do not have more than 50 Eligible Employees and ensure
			 that those Eligible Small Businesses will be disenrolled at the end of the
			 current plan year if the number of Eligible Employees increases beyond 50 in
			 total;
3. Ensure that the Group
			 Purchasing Cooperative will offer Health Benefit Plans to Qualified
			 Associations that are new to the Group Purchasing Cooperative only on Health
			 Benefit Plan anniversary dates;
4.
			 Ensure that Qualified Associations and Qualified Association Members forfeit
			 annual membership fees if they choose, on dates other than Health Benefit Plan
			 anniversary dates, to cease being offered a Health Benefit Plan(s) through the
			 Group Purchasing Cooperative;
5.
			 Ensure that the Group Purchasing Cooperative will not offer Health Benefit
			 Plans to any Qualified Association or Qualified Association Member that has,
			 within the past three years, chosen to cease being offered a Health Benefit
			 Plan(s) through a Group Purchasing Cooperative; and
6. Ensure consistent application of open
			 enrollment rules and periods according to documented procedures for Qualified
			 Association Members to enter and exit Group Purchasing Cooperatives for the
			 purchase of Health Benefit Plans;
(d) The applicant has marketing systems that
			 present Group Purchasing Cooperative Health Benefit Plans to Eligible
			 Association Members and Qualified Association Members' Eligible Employees and
			 Eligible Dependents, which may include marketing through duly licensed
			 insurance producers;
(e) The
			 applicant has billing systems that ensure that no Eligible Small Business in a
			 Group Purchasing Cooperative is charged a rate higher than what the Carrier
			 would charge to a similarly situated Eligible Small Business that is not a
			 participant in a Group Purchasing Cooperative;
(f) The applicant has Wellness Programs
			 administered by the Group Purchasing Cooperative or its designees that, at a
			 minimum:
1. Are actuarially similar to
			 Wellness Programs that may be offered through the Commonwealth Health Insurance
			 Connector Authority and meet the standards of
			 211
			 CMR 151.15;
2. Will received an enrollment commitment
			 from at least 33% of all Eligible Association Members and Eligible Employees
			 that will be covered under Health Benefit Plans offered through the Group
			 Purchasing Cooperative; and
3. Have
			 reasonable systems, which shall comply with any applicable sections of the
			 Americans with Disability Act and any other federal requirements, under which
			 Wellness Program participants may record their participation in, and the Group
			 Purchasing Cooperative may monitor Wellness Program participants' participation
			 in available health management programs;
(g) The applicant has informational systems,
			 including but not limited to data redundancy and privacy controls, that ensure
			 the appropriate and efficient use of Covered Benefits;
(h) The applicant has operations financially
			 capable of coordinating the Group Purchasing Cooperative's Wellness Program
			 with Eligible Association Members or Eligible Small Businesses;
(i) The applicant has a written Group
			 Purchasing Cooperative marketing plan for attracting Eligible Association
			 Members and Eligible Small Businesses to obtain coverage from the Group
			 Purchasing Cooperative;
(j) The
			 applicant has adequate Wellness Programs to guarantee that all wellness
			 services contracted for will be accessible to Eligible Association Members,
			 Eligible Employees and Eligible Dependents without inappropriate delays;
			 and
(k) The applicant has
			 sufficient financial reserves or other resources to meet financial
			 obligations.