Current through Register Vol. XLI, No. 50, December 13, 2024
Section 85-21-7 - Plan Modifications7.1. A managed health care plan, which either implements or experiences material variations as to any matter set forth in the original application or managed care plan, shall obtain approval for the modification by filing a request for modification with the Commission or upon termination of the Commission, the insurance commissioner. a. Intended variations shall not be implemented until approved by the Commission or upon termination of the Commission, the insurance commissioner.b. A modification outside the control of the system shall be filed with the Commission within fifteen (15) days of its occurrence.7.2. Within fifteen (15) days of entering into an agreement with an employer or insurer to provide workers' compensation managed care services, the managed health care plan shall submit notification thereof to the Commission or upon termination of the Commission, the insurance commissioner. The notification shall identify the employer or employers with whom the managed health care plan has contracted and the certified managed care plan applicable to that employer. Notification shall be deemed approved unless disapproved by the Commission or upon termination of the Commission, the insurance commissioner, in writing within thirty (30) days of filing. The plan shall promptly furnish any information deemed necessary by the Commission or upon termination of the Commission, the insurance commissioner, to review the notice. When an employer or insurer terminates a contract with a managed health care plan, the managed health care plan shall file notification with the Commission or upon termination of the Commission, the insurance commissioner, within fifteen (15) days of the occurrence, indicating the employers for whom managed care services have been terminated and the effective date of the termination.