Chapter 176I

Section 1. The following words as used in this chapter shall have the meanings given to them in this section unless the context clearly requires otherwise: ''Commissioner'', the commissioner of insurance. ''Covered person'', any policy holder or other person on whose behalf the o…

Section 10. Any organization which has entered into preferred provider arrangements prior to the effective date of this chapter shall file an application within ninety days of the effective date of this chapter, and may continue to operate until such time as its application may b…

Section 11. (a) Every organization other than a workers' compensation insurer, operating a preferred provider arrangement shall annually pay an assessment equal to two and twenty-eight hundredths per cent of the gross premiums received during the preceding calendar year for cover…

Section 12. An organization entering into a preferred provider contract that covers a child under the age of 18 shall provide coverage for the cost of treating cleft lip and cleft palate for the child. The coverage shall include benefits for medical, dental, oral and facial surge…

Section 13. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings: ''Behavioral health services'', care and services for the evaluation, diagnosis, treatment or management of patients with menta…

Section 2. An organization may enter into a preferred provider arrangement with one or more health care providers upon a determination by the commissioner that the organization and the arrangement comply with the requirements of this chapter and the regulations hereunder. An orga…

Section 3. Organizations, but not an insurer as defined in paragraph (7) of section one of chapter one hundred and fifty-two, may offer health benefit plans which provide for incentives for covered persons to use the health care services of preferred providers. Such health benefi…

Section 3A. The requirement of subsections (b) (c) and (d) of section three shall apply to organizations that furnish workers' compensation medical services through a preferred provider arrangement.

Section 4. An organization shall not refuse to enter into a preferred provider arrangement with a health care provider on the basis of religion, race, color, national origin, age, sex, marital status, sexual orientation, or such provider's relationships with any other organizatio…

Section 4A. For the purposes of this section the following words shall have the following meanings:— ''Genetic information'', a written recorded individually identifiable result of a genetic test as defined by this section or explanation of such a result. ''Genetic test'', a test…

Section 5. An organization shall maintain financial and utilization records for its preferred provider arrangements and activities in a form separate or separable from the financial and utilization records of other operations and activities carried on by the organization.

Section 6. An organization shall furnish to the commissioner evidence of a surety bond, reinsurance or other financial resources in an amount satisfactory to the commissioner as a guarantee that obligations to covered persons will be performed.

Section 7. An organization which enters into a preferred provider arrangement shall file annually with the commissioner, within one hundred and twenty days of the close of its fiscal year, a report covering its prior fiscal year. The report shall include: (a) the number of covere…

Section 8. In addition to other powers specified in this chapter, the commissioner may, after due hearing: (a) promulgate appropriate rules and regulations necessary to the administration and enforcement of this chapter; (b) issue an order requiring any person or organization to …

Section 9. An organization which offers or administers a health benefit plan or furnishes workers' compensation, under a preferred provider arrangement shall be subject to all of the provisions of its enabling or licensing statute and of any other provisions of the general laws a…