Section 4540.50 Material Changes to a Network

Section 4540.50  Material

Changes to a Network

a)         Within 15 days after any material change in an approved

network plan, an insurer must submit a material change filing.  The insurer

shall submit a revised version of the most recent network adequacy filing

described in Section 4540.40 based on the material change and shall identify

the SERFF Tracking Number of the annual filing that the material change filing

is updating.  The material change filing must show the changes for each

document that was revised from the annual filing and must ensure that any exemptions

requested under Section 10(g) of the Act account for the material change.

Including when a major health system is removed from a network, an insurer is

only required to submit information related to the provider specialty type or

types affected by the material change and, unless the network as a whole

experienced a 10% reduction, only in the county or counties where beneficiaries

were affected by the material change.  Material change filings do not need to

include any documents described in Section 4540.40(k) through (o) or (s).

b)         An insurer may request a 15-day extension to submit the

filing described in this Section if, by the original deadline, the insurer

reports to the Department the specific triggers for the material change, the

provider specialty types known to be affected, the counties known to be

affected, and the aggregate number of current beneficiaries affected.  The

Department will not unreasonably withhold approval of an extension satisfying

these criteria.