211 CMR, § 147.04

Current through Register 1533, October 25, 2024

Section 147.04 - Administrative Cost Expenditure

Unless otherwise determined by the Commissioner, the following items shall be deemed to be an Administrative Cost Expenditure for the purposes of calculating and reporting the MLR of Health Benefit Plans for M.G.L. c. 176J, § 6 and M.G.L. c. 176O, § 21:

(a) Financial administration expenses;

(b) Marketing and sales expenses;

(c) Distribution expenses;

(d) Claims operations expenses;

(e) Medical administration expenses, such as disease management, care management, utilization review and medical management activities;

(f) Network operations expenses;

(g) Charitable expenses;

(h) Board, bureau or association fees;

(i) State and federal tax expenses, including assessments; and

(j) Payroll expenses.

211 CMR, § 147.04

Amended by Mass Register Issue 1351, eff. 11/3/2017.