Bill > H1107

This bill aims to strengthen health insurer reserve requirements in Massachusetts. The key provisions include: 1. Requiring health insurers to submit annual comprehensive financial statements to the Division of Insurance, detailing information such as premiums, claims, medical loss ratios, membership, expenses, and risk-based capital ratios. This data will be made public and shared with the Center for Health Information and Analysis. 2. Requiring insurers that provide administrative services to self-insured groups to report additional details about those self-insured customers, including the number of members, lives covered, premiums, claims, and medical loss ratios. 3. Establishing a formula for insurers to allocate a portion of their reserves to certified risk-bearing provider organizations based on the level of downside risk transferred to those providers. 4. Requiring the Division of Insurance to hold a public hearing if an insurer reports a risk-based capital ratio exceeding 600%, and to review the insurer's financial condition and plans to use surplus to reduce health plan costs. 5. Authorizing the Commissioner of Insurance to waive specific reporting requirements for certain classes of insurers, with notice to legislative committees. The bill aims to increase transparency and accountability around insurer finances, reserves, and the sharing of risk with providers, with the goal of ensuring adequate reserves while also reducing health care costs for consumers.

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https://malegislature.gov/Bills/192/H1107