Other information for insurers

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

Regulatory guidance related to health reform

Required insurer reporting

  • 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.