Current through Register 1527, August 2, 2024
Section 152.03 - Limited and Regional Provider Network Plans(1) A Carrier proposing to offer a Health Benefit Plan that uses a Limited Provider Network or a Regional Provider Network shall submit to the Division materials demonstrating that: (a) The Carrier has notified each Provider of its right to opt out of a new Health Benefit Plan with a Limited Provider Network or a Regional Provider Network at least 60 days before the Carrier submits the new plan to the Commissioner; and(b) The Carrier maintains up to date enrollment systems, Marketing Materials and Evidences of Coverage that identify for all Providers, employers and Insureds the Provider Network available through the Insured's Health Benefit Plan.(2) A Carrier shall use defined criteria and evaluation systems that are coordinated by appropriate Carrier staff and overseen by the Carrier's medical director to develop Provider Networks to maintain Network Adequacy.