Mississippi Administrative Code

A. Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant currently has Medicare supplement, Medicare Advantage, Medicaid coverage, or another health insurance policy or certificate in…

An issuer shall provide a copy of any Medicare supplement advertisement intended for use in this state whether through written, radio or television medium to the Commissioner of Insurance of this state for review or approval by the commissioner to the extent it may be required un…

A. An issuer, directly or through its producers, shall: 1. Establish marketing procedures to assure that any comparison of policies by its agents or other producers will be fair and accurate. 2. Establish marketing procedures to assure excessive insurance is not sold or issued. 3…

A. In recommending the purchase or replacement of any Medicare supplement policy or certificate an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement. B. Any sale of a Medicare supplement policy or certificate that will p…

A. On or before March 1 of each year, an issuer shall report the following information for every individual resident of this state for which the issuer has in force more than one Medicare supplement policy or certificate: 1. Policy and certificate number; and 2. Date of issuance.…

A. If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate, the replacing issuer shall waive any time periods applicable to preexisting conditions, waiting periods, elimination periods and probationary periods in the new Medicare …

This Section applies to all policies with policy years beginning on or after May 21, 2009. A. An issuer of a Medicare supplement policy or certificate; 1. Shall not deny or condition the issuance or effectiveness of the policy or certificate (including the imposition of any exclu…

If any provision of this regulation or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the regulation and the application of such provision to other persons or circumstances shall not be affected thereby Notes 19 Miss. …

This regulation and its amendments shall be effective on and after January 1, 2020. Notes 19 Miss. Code. R. 3-10.26 Miss Code Ann § 25-43-3.113(Rev. 2010) Amended 1/1/2020

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Click Here To View Image Notes 19 Miss. Code. R. 3-10.28 Miss Code Ann §839-103(Rev. 2011) Amended 1/1/2020

DISCLOSURE STATEMENTS Instructions for Use of the Disclosure Statements for Health Insurance Policies Sold to Medicare Beneficiaries that Duplicate Medicare 1. Section 1882 (d) of the federal Social Security Act [ 42 U.S.C. 1395 ss] prohibits the sale of a health insurance policy…

This Regulation is promulgated pursuant to the authority vested in the Commissioner of Insurance under Article 7 and Article 9 of Chapter 41 of Title 83 of the Mississippi Code of 1972, Annotated, and is promulgated in accordance with Mississippi Insurance Department Regulation N…

This Regulation requires a managed care entity to establish a comprehensive health care professional credentialing verification program to ensure that its participating health care professionals meet specific minimum standards of professional qualification. The standards set out …

For purposes of this Regulation: A. "Commissioner" means the Commissioner of Insurance. B. "Credentialing verification" is the process of obtaining and verifying information about a health care professional, and evaluating the professional credentials of that health care professi…

This Regulation shall apply to managed care entities that offer, operate or participate in managed care plans. Notes 19 Miss. Code. R. 3-11.04 Miss Code Ann §§ 83-5-1; 83-41-413 (Rev. 2011)

A. A managed care entity shall: 1. Establish written policies and procedures for credentialing verification of all health care professionals with whom the managed care entity contracts and apply these standards consistently; 2. Verify the credentials of a health care professional…

A managed care entity shall: A. Obtain primary verification of at least the following information about the applicant: 1. Current license or certification to practice in this and all other states and history of licensure or certification; 2. Status of primary admitting hospital p…

A. In order to simplify the application process for physicians who are applying to multiple managed care entities, the Commissioner hereby adopts a basic uniform credentialing application which shall be used by all managed care entities performing physician credentialing and recr…

Subject to the provisions of Subsections A., B., C., and D. of this Section, a managed care entity shall provide a health care professional with the sources from which credentialing information is received, notification of any information that varies substantially from the inform…

Whenever a managed care entity delegates the credentialing functions required by this Regulation to another entity, the commissioner shall hold the managed care entity responsible for monitoring the activities of the delegatee entity in order to ensure that the requirements of th…

If any provision of the Regulation, or the application of the provision to any person or circumstance, shall be held invalid, the remainder of the Regulation, and the application of the provision to persons or circumstances other than those to which it is held invalid, shall not …

This Regulation shall become effective thirty (30) days after filing with the Office of the Secretary of State of the State of Mississippi. Notes 19 Miss. Code. R. 3-11.11 Miss Code Ann § 25-43-3.113(Rev. 2010)

To effectively use the Application, the following is suggested: Type or legibly complete the Application in black ink. A. Complete all of the Application except for line 1, "This application is submitted to,___". Do not sign and date the original. Keep the completed original on f…

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This Regulation is promulgated pursuant to the authority vested in the Commissioner of Insurance under Miss. Code Ann. §§ 83-1-43 and 83-5-1 (Rev. 1999), and is promulgated in accordance with Mississippi Insurance Department Regulation No. 88-101, said Regulation being the Rules …

In order to fully comply with the Health Insurance Portability and Accountability Act of 1996, as Amended, including information issued by the Health Care Financing Administration to the Mississippi Department of Insurance regarding the enforcement thereof, this Regulation is pro…

As used in this Regulation, the term "health insurance issuer" shall mean any insurance company, hospital or medical service plan or any entity defined in Miss. Code Ann. § 83-41-303(n)(Rev. 1999), which offers group or individual insurance coverage in the State of Mississippi. N…

A. A health insurance issuer shall not, except as provided in subsection B. of this Section: 1. Restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child following a normal vaginal delivery to less than forty-eight (48) hours;…

A health insurance issuer offering a group or individual health insurance coverage shall not: A. Deny to the mother or her newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the policy solely for the purpose of avoiding the requ…

A. Nothing in this Regulation shall be construed to require a mother who is an insured or enrollee: 1. To give birth in a hospital; or 2. To stay in the hospital for a fixed period of time following the birth of her child. B. This Regulation shall not apply with respect to any gr…

A health insurance issuer providing group or individual health insurance coverage shall provide notice to the named insured in the case of an individual policy, and to each certificate holder in the case of a group policy, regarding the coverage required by this Regulation. Such …

The effective date of this Regulation shall be thirty (30) days from and after its adoption and filing with the Secretary of State of the State of Mississippi. Notes 19 Miss. Code. R. 3-12.08 Miss. Code Ann. § 25-43-3.113 (Rev. 2010)

This Regulation is promulgated pursuant to the authority vested in the Commissioner of Insurance under Miss. Code Ann. §§ 83-1-43 and 83-5-1 (Rev. 1999).and is promulgated in accordance with Mississippi Insurance Department Regulation No. 88-101, said Regulation being the Rules o…

In order to fully comply with the Health Insurance Portability and Accountability Act of 1996, as Amended, including instructions issued by the Health Care Financing Administration regarding the enforcement thereof, this Regulation is promulgated to require health insurance issue…

As used in this Regulation, the term "health insurance issuer" shall mean any insurance company, hospital or medical service plan or any entity defined in Miss. Code Ann. § 83-41-303(n)(Rev. 1999), which offers group or individual health insurance coverage in the State of Mississ…

A health insurance issuer providing group or individual health insurance coverage that provides medical and surgical benefits with respect to a mastectomy shall provide an insured or enrollee who is receiving benefits in connection with a mastectomy and whoelects breast reconstru…

A. A health insurance issuer offering group or individual health insurance coverage may not: 1. Deny to a patient eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the policy solely for the purpose of avoiding the requirements of this Regula…

A health insurance issuer providing group or individual health insurance coverage shall provide notice to the named insured in the case of an individual policy, and to each certificate holder in the case of a group policy, regarding the coverage required by this Regulation. Such …

This Regulation does not apply to any group health insurance coverage in relation to its provision of excepted benefits described in 42 U.S.C. § 300gg-21(c) and (d), and does not apply to any individual health insurance coverage in relation to its provision of expected benefits d…

The effective date of this Regulation shall be thirty (30) days from and after its adoption and filing with the Secretary of State of the State of Mississippi. Notes 19 Miss. Code. R. 3-13.08 Miss. Code Ann. § 25-43-3.113 (Rev. 2010)

This Regulation shall be known and may be cited as the Managed Care Plan Network Adequacy Regulation and is promulgated by the Commissioner of Insurance pursuant to the authority granted to him by Title 83, the Mississippi Insurance Code; the requirements of Miss. Code Ann. § 25-…

The purpose of this Regulation is to establish standards for the creation and maintenance of networks by health carriers and to ensure adequate access to covered persons in a managed care plan. This Regulation enhances the adequacy, accessibility, and quality of health care servi…

For purposes of this Regulation: A. "Commissioner" means the Commissioner of Insurance. B. "Covered benefits" or "benefits" means those health care services to which a covered person is entitled under the terms of a health benefit plan. C. "Covered person" means a policyholder, s…

This Regulation shall apply to all health carriers that offer managed care plans; provided, however, the Regulation shall not apply to the Mississippi State Employee Health Plan or to any managed care plan regulated by the Mississippi Division of Medicaid, or to any self-insured …

A. A health earner providing a managed care plan shall maintain a network that is sufficient in numbers and types of participating providers to ensure that all covered services to covered persons will be accessible without unreasonable delay. In the case of emergency facility ser…

A health carrier offering a managed care plan shall meet the following requirements contained in this section, in addition to any other requirements required under Mississippi law. A. A health carrier shall establish a mechanism by which the participating provider will be notifie…