Section 149.07 - Information Relative to Administrative Services Provided to Self-insured Groups(1) For the purposes of 211 CMR 149.07 only, the following words shall mean: (a)Carrier or Health Insurer: An insurer licensed or otherwise authorized to transact accident or health insurance under M.G.L. c. 175; a nonprofit hospital service corporation organized under M.G.L. c. 176A; a nonprofit medical service corporation organized under M.G.L. c. 176B; a health maintenance organization licensed under M.G.L. c. 176G; and an organization entering into a preferred provider arrangement under M.G.L. c. 176I. Carrier or Health Insurer shall not include any entity to the extent it offers a policy, certificate or contract that does not qualify as creditable coverage as defined in M.G.L. c. 111M, §1; provided, however, that "Carrier or Health Insurer" shall include an entity that offers a policy, certificate or contract that provides coverage solely for dental care services or vision care services. Carrier or Health Insurer shall not include an employer purchasing coverage or acting on behalf of its employees or the employees of one or more subsidiaries or affiliated corporations of the employer, or any entity acting solely as a Third-party Administrator.(b)Self-insured Customer: A Self-insured Group for which a Third-party Administrator provides administrative services related to receiving or collecting charges, contributions or premiums for, or adjusting of settling claims on or for residents of the Commonwealth.(c)Self-insured Group Plan: A self-insured or self-funded employment-based group health plan.(d)Third-party Administrator: A person domiciled inside or outside of the Commonwealth who, on behalf of a Health Insurer or purchaser of health benefits, receives or collects charges, contributions or premiums for, or adjusts or settles claims on or for residents of the Commonwealth. Unless noted otherwise, a purchaser of health benefits shall not include an entity to the extent it offers a policy, certificate or contract that does not qualify as creditable coverage as defined in M.G.L. c. 111M, § 1; provided, however, that a purchaser of health benefits shall include an entity that offers a policy, certificate or contract that provides coverage solely for dental care services or vision care services. Third-party Administrator shall also include pharmacy benefit managers and any other entity with claims data, eligibility data, provider files and other information relating to health care provided to residents of the Commonwealth and health care provided by health care providers in the Commonwealth, except that Third-party Administrator shall not include an entity that administers only claims data, eligibility data, provider files and other information for its own employees and dependents.(2) Any Carrier which is required to file an Annual Comprehensive Financial Statement pursuant to M.G.L. c. 176O, § 21(a) and which provides administrative services to one or more Self-insured Groups shall submit to the Division an appendix to the Annual Comprehensive Financial Statement on a form approved by the Commissioner. The appendix to the Annual Comprehensive Financial Statement shall be submitted electronically on or before April 1st for the year ended December 31st immediately preceding and shall include the following information: (a) The number of the Carrier's Self-insured Customers as of December 31st;(b) The aggregate number of subscriber members enrolled in the benefit plans administered for all of the Carrier's Self-insured Customers, including: 1. Number of subscriber members covered on December 31st;2. Number of subscriber member months covered in prior calendar year; and3. Average number of subscriber members for prior calendar year; and(c) The aggregate number of subscriber and dependent lives covered in the benefit plans administered for all of the Carrier's Self-insured Customers, including: 1. Number of total subscriber and dependent covered lives on December 31st;2. Number of total subscriber and dependent covered life months covered in prior calendar year; and3. Average number of subscriber and dependent covered lives in prior calendar year.(d) The aggregate value of direct premiums earned for all of the Carrier's Self-insured Customers;(e) The aggregate value of direct claims incurred for all of the Carrier's Self-insured Customers;(f) The aggregate Medical Loss Ratio for all of the Carrier's Self-insured Customers;(i) Accumulated reserves;(j) The percentage of the Carrier's Self-insured Customers that include each of the benefits mandated for health benefit plans under M.G.L. chs. 175, 176A, 176B and 176G;(k) The aggregated administrative service fees paid by all of the Carrier's Self-insured Customers; and (l) Any other information requested by the Commissioner.(3) If a Carrier is unable to provide any of the required information set forth in 211 CMR 149.07(2) in the appendix to its Annual Comprehensive Financial Statement, the Carrier shall provide a detailed explanation, within the Annual Comprehensive Financial Statement, of the reason(s) that such required information is not available.(4) A Carrier that provides administrative services to one or more Self-insured Groups and fails to submit the appendix to its Annual Comprehensive Financial Statement to the Division on or before April 1st of each year shall be assessed a late penalty by the Commissioner not to exceed $100.00 per day.