Health insurance regulation

Information for health insurers

These pages provide regulatory guidance and describe processes and required reports for health insurers.

Annual Network Adequacy Reporting. Documents, checklists and reference files to assist in filing Annual Network Adequacy reports.
Behavioral Health Parity Reporting. All carriers offering health benefit plans that provide behavioral health benefits are required to submit data and reporting forms to comply with requirements outlined in HB 3046.
External review outlines procedures insurers must follow once a policyholder requests an external, or independent, review of an unfavorable claim decision.
Patient protection reports require insurers to provide information on such topics as network adequacy and pre-authorization processes.
Health benefit plans provide key financial data such as net income and percent of premium spent on medical care versus overhead.
Quarterly enrollment reports capture enrollment data by insurance market.
Primary Care Spending Report — HB 4017
Primary Care Spending Reporting Template Guidelines
Primary Care Spending Report list of codes for 2019 Report
2019 Association, Trust, and MEWA Data Call