Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 121.00 - Procedures Concerning Rate Filings Made Pursuant To M.g.l. C. 176k, And The Conduct Of Hearings On Such Filings › Section 121.01 - Definitions

Current through Register 1525, July 5, 2024
As used in
				211 CMR 121.00, the
				following words shall mean:
Amended Filing
. A Rate Filing that the
				Presiding Officer, in his or her discretion, has permitted to be
				amended.
Commissioner
. The Commissioner of
				Insurance appointed pursuant to M.G.L. c. 26, § 6, or his or her
				designee.
Division
. The Division of Insurance
				established pursuant to M.G.L. c. 26, § 1.
Docket Clerk
. The person who controls
				and maintains the docket files that contain the records of Hearings held at the
				Division.
Filer
. An Issuer or a Health
				Maintenance Organization that files a Rate Filing in accordance with the
				provisions of M.G.L. c. 176K.
Hearing
. The part of a Proceeding in
				which sworn testimony, oral and written, and Papers and other documentary
				evidence are submitted for consideration by the Commissioner.
Information Request
. A written request
				to a Party for production of documents or tangible things.
Intervenor
. A person, agency or
				organization likely to be substantially and specifically affected by a Rate
				Filing that is granted Intervenor status pursuant to conditions established by
				the Presiding Officer.
Issuer
. A company, as defined in
				M.G.L. c. 175, § 1, that is authorized to write accident and health
				insurance; a hospital service corporation as defined in M.G.L. c. 176A, §
				1; a medical service corporation as defined in M.G.L. c. 176B, § 1; a
				Fraternal Benefit Society, authorized under M.G.L. c. 176; or a Health
				Maintenance Organization licensed under M.G.L. c. 176G; that in the
				Commonwealth offers, sells, delivers or otherwise makes effective, or renews in
				Massachusetts Medicare Supplement Insurance Policies. For purposes of
				determining whether an Issuer is offering a non-network Medicare Supplement
				plan, an Issuer shall include the Issuer, its parent company or companies, its
				affiliated companies, and/or its subsidiary companies.
Medicare
. "Health Insurance for the
				Aged Act," Title XVIII of the Social Security Act Amendments of 1965.
Medicare Supplement Insurance or
				Policy
. A type of health insurance issued by a carrier, other than
				a policy issued pursuant to a contract under Section 1876 or Section 1833 of
				the federal Social Security Act (
				42 U.S.C. Section
				1395
et seq
.), or a policy
				issued under a demonstration project authorized pursuant to amendments to the
				federal Social Security Act, which is advertised, marketed or designed
				primarily as a supplement to reimbursements under Medicare for the hospital,
				medical or surgical expenses of persons eligible for Medicare. Unless specified
				otherwise, references in
				211 CMR 121.00 to Medicare
				Supplement Insurance or Policy are intended to refer collectively to Medicare
				Supplement Insurance or Policy and Medicare Select Insurance or Policy.
Medicare Select Insurance or Policy
. A
				Medicare Supplement Insurance or Policy that contains Restricted Network
				Provisions. Unless specified otherwise, references in
				211 CMR 121.00 to Medicare
				Supplement Insurance or Policy are intended to refer collectively to Medicare
				Supplement Insurance or Policy and Medicare Select Insurance or Policy.
Papers
. All written documents filed in
				a proceeding, including Rate Filings, Responsive Filings, motions, pleadings,
				briefs, memoranda and other communications.
Participant
. A person, agency, or
				organization that is granted permission to participate in a Proceeding on a
				limited basis as determined by the Presiding Officer.
Party
. A Filer, the State Rating
				Bureau, a Statutory Intervenor, or an Intervenor.
Policy
. Any Policy, Certificate,
				contract, agreement, statement of coverage, rider or endorsement issued by an
				Issuer as defined herein which provides Medicare Supplement Insurance as
				defined herein other than a policy issued pursuant to a contract under Section
				1876 of the federal Social Security Act (
				42 U.S.C. Section
				1395
et seq
.) or an issued
				policy under a demonstration project specified in
				42
				U.S.C. §
									1395ss(g)(1),
				which provides Medicare Supplement Insurance as defined herein. The term
				"Policy," unless stated otherwise within
				211 CMR 71.00:
Medicare Supplement Insurance to Facilitate the Implementation of
				M.G.L. c. 176K and Section 1882 of the Federal Social Security Act
,
				includes any Alternate Innovative Benefits Riders.
Policy
does not include Medicare Advantage plans
				established under Medicare Part C, Outpatient Prescription Drug plans
				established under Medicare Part D, or any Health Care Prepayment Plan (HCPP)
				that provides benefits pursuant to an agreement under § 1833(a)(1)(A) of
				the Social Security Act.
Presiding Officer
. The Commissioner or
				a person or persons designated by the Commissioner to conduct Proceedings
				pursuant to
				211 CMR 121.00.
Proceeding
. The public hearing process
				under M.G.L. c. 176K, § 7(g), by which the Commissioner reviews and
				addresses a Rate Filing.
Public Comment Hearing
. The part of a
				Proceeding in which persons are given an opportunity to make oral statements
				about a Rate Filing. Written statements may be submitted at a Public Comment
				Hearing or at any time prior to the closing of the Proceeding.
Rate Filing or Filing
. Documents filed
				with the Commissioner by a Filer pursuant to M.G.L. c. 176K.
Record Request
. A request for
				production of documents or tangible things made to a Party during a
				Proceeding.
Responsive Filing
. Any
				recommendations, including supporting information or commentary, concerning a
				Rate Filing, or any portion thereof, filed in accordance with
				211 CMR
				121.09.
Revised Rate Filing
. A Rate Filing
				that has been revised to respond to the issues that resulted in disapproval of
				a Rate Filing.
State Rating Bureau
. The rating bureau
				in the Division established pursuant to M.G.L. c. 26, § 8E.
Statutory Intervenor
. A person, agency
				or organization, including, but not limited to, the Attorney General, that has
				a statutory right to appear as an Intervenor in a Proceeding.
Technical Conference
. A conference
				convened by the Presiding Officer to enable the Parties to narrow the issues in
				dispute. A Technical Conference may involve examination and cross-examination
				of sworn witnesses in order to clarify the technical aspects of a Rate Filing.
				Topics of such inquiry may include the data relied upon by the Filer, the
				projection trends selected, and applicable federal law.