Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 152.00 - Health Benefit Plans Using Limited, Regional Or Tiered Provider Networks › Section 152.06 - Marketing of and Enrollment in Limited, Regional and Tiered Provider Network Plans

Current through Register 1525, July 5, 2024
(1)
Marketing of Limited, Regional and Tiered Provider Network
			 Plans.
(a) Nothing in 211 CMR
			 152.06 shall affect a Carrier's obligation to comply with the requirements of
			 211 CMR 40.00.
(b) All Advertisements and Marketing
			 Materials shall clearly identify the Health Benefit Plans being offered by the
			 Carrier that only provide access through a Limited Provider Network, Regional
			 Provider Network or Tiered Provider Network. Carriers shall ensure that such
			 Advertisements and Marketing Materials specifically use the following terms as
			 applicable to the product: "Limited Provider Network", "Regional Provider
			 Network" or "Tiered Provider Network" so that Providers, employers and
			 subscribers and prospective subscribers may be fully informed about the
			 Provider Network features applicable to the offered Health Benefit Plan. In
			 addition, Carriers shall establish auditable internal marketing procedures,
			 methods for assuring compliance by Insurance Producers and prohibitions against
			 high-pressure tactics.
(c) All
			 Advertisements and Marketing Materials used in the sale, solicitation or
			 negotiation of a Carrier's Health Benefit Plan that uses a Limited Provider
			 Network, a Regional Provider Network or a Tiered Provider Network shall clearly
			 disclose to prospective Insureds the type of Provider Network and the exact
			 name of the Provider Network used for the plan. Insurance producers selling,
			 soliciting or negotiating a Carrier's Health Benefit Plan that uses a Limited
			 Provider Network, Regional Provider Network or Tiered Provider Network shall
			 use only those Advertisements or Marketing Materials that contain such a
			 disclosure.
(d) All Advertisements
			 and Marketing Materials used in the sale, solicitation or negotiation of a
			 Carrier's Health Benefit Plan that uses a Limited Provider Network, a Regional
			 Provider Network or a Tiered Provider Network shall include the following
			 disclosures:
1. The first or cover page of
			 the Advertisements or Marketing Material, or electronic drop down menu of a
			 web-based page, shall prominently disclose in a clear and conspicuous manner
			 how to access a list of the Provider Network Providers and how to request a
			 paper copy of the Health Benefit Plan's provider directory and shall provide a
			 Provider Network description statement substantially similar to the following:
a.
Limited/Regional Provider
			 Network
. This plan provides access to a network that is smaller
			 than [Name of Carrier]'s [general provider network name] provider network. In
			 this plan members have access to network benefits only from the providers in
			 [name of network]. Please consult the [Limited/Regional] provider directory or
			 visit the provider search tool at [web address] to determine which providers
			 are included in the [name of network]."
b.
Tiered Provider
			 Network
. This plan includes the Tiered Provider Network called
			 [name of network]. In this plan members pay different levels of [copayments,
			 coinsurance, deductibles] depending on the tier of the provider delivering a
			 covered service or supply. This plan may make changes to a provider's benefit
			 tier annually on [identify date]. Please consult the [name of network] provider
			 directory or visit the provider search tool at [web address] to determine the
			 tier of providers in [name of network]."
(e) A Carrier shall provide appropriate
			 training to any employee or Insurance Producer selling, soliciting or
			 negotiating its insurance products about the Carrier's Health Benefit Plans
			 that use Limited Provider Networks, Regional Provider Networks or Tiered
			 Provider Networks. Carriers shall maintain records of those employees and
			 Insurance Producers who have satisfactorily completed such training and make
			 such information available to the Commissioner upon request.