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.