Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 43.00 - Health Maintenance Organizations (HMOs) › Section 43.04 - Reporting

Current through Register 1525, July 5, 2024
(1)
Financial
			 Concerns
. Each HMO shall inform the Commissioner of any
			 extraordinary loss or claim which has the potential to render it unable to meet
			 its obligations as they become due, within five business days of its
			 occurrence.
(2)
Quarterly Filings
. Within 45 days of the close of each
			 fiscal quarter, the Division will collect information according to the format
			 specified by the NAIC or otherwise as specified by the Commissioner.
(3)
Unaudited Annual
			 Reports
. Each year, every HMO shall file with the Commissioner, on
			 or before March 1st, a report about the HMO's
			 preceding fiscal year that is verified by at least two principal executive
			 officers, in the format specified by the NAIC or otherwise specified by the
			 Commissioner in accordance with the provisions of M.G.L. c. 176G, § 10;
			 provided, that if the Commissioner determines that a threat of insolvency
			 exists to the HMO, he or she may require that such report be made available
			 prior to March 1st; in the alternative, as
			 authorized by the Commissioner, the Commissioner may obtain certain annual
			 reporting information from an alternate source.
(a) Such annual report shall be made on the
			 latest applicable form of annual statement approved by the NAIC, with any
			 additional information the Commissioner may require for filing with the NAIC
			 for the purpose of eliciting a complete and accurate exhibit of the condition
			 and transactions of the HMO. All financial information reflected in the annual
			 statement shall be maintained and prepared in accordance with accounting
			 practices and procedures prescribed or permitted by the Commissioner. The
			 Commissioner shall require that the annual statement be maintained and prepared
			 in accordance with the Annual Statement Instructions and Accounting Practices
			 and Procedures Manual adopted by the NAIC unless further modified by the
			 Commissioner as he or she considers appropriate. The annual statement shall be
			 subscribed and sworn to by its president and secretary or, in their absence, by
			 two of its principal executive officers. The Commissioner may at other times
			 require any such statements as he or she may deem necessary.
(b) A copy of such annual report shall be
			 sent to the NAIC in an electronic filing form as provided by the
			 NAIC.
(c) Each domestic and foreign
			 HMO authorized to transact insurance in Massachusetts shall annually on or
			 before March 1st, file with the NAIC a copy of its
			 annual statement blank, along with such additional filings as prescribed by the
			 Commissioner for the preceding year. The information filed with the NAIC shall
			 be in the same format and scope as that required by the Commissioner and shall
			 include the signed jurat page and the actuarial certification. Any amendment or
			 addendum to the annual statement filing subsequently filed with the
			 Commissioner shall also be filed with the NAIC. Foreign HMOs that are domiciled
			 in a state that has a law substantially similar to 211 CMR 43.04 shall be
			 deemed to be in compliance with 211 CMR 43.04.
(d) The reporting provisions of 211 CMR
			 43.04(3) shall apply to all domestic, foreign and alien HMOs that are
			 authorized to transact business in Massachusetts.