Circular Letter No. 11  (1995)

July 21, 1995


All Insurers Licensed to Write Motor Vehicle Liability Insurance in New York State


No-Fault Managed Care Coverage

The 23rd Amendment to Insurance Department Regulation No. 68 and the 22nd Amendment to Regulation No. 83 will take effect on August 15, 1995. These amendments implement Chapter 726 of the Laws of 1993, which permits motor vehicle insurers to offer No-Fault managed care coverage on an optional basis to their policyholders who, in return for a premium discount, elect to be covered under a managed care program.

Insurers that choose to offer managed care coverage must file a Managed Care Program (MCP) with the Department for approval. These programs must utilize the services of managed care organizations (MCOs), certified by the Superintendent as qualified to provide health care services pursuant to No-Fault managed care programs.

The enclosed MCP application must be submitted by all insurers that wish to apply for approval to provide managed care coverage. All of the requirements specified in the MCP application must be satisfied by the insurer for each service area (delineated on a county-by-county basis) where the insurer elects to offer managed care coverage.

Also enclosed are copies of the application for certification as an MCO. The MCO application contains the minimum requirements for certification as an MCO and must be completed by all applicants for certification. Insurers may distribute the certification application to those interested in applying for certification.

An MCO may also wish to provide some of the services required of an insurer's managed care program. The Department will authorize MCOs to provide additional specific services if the requirements of Regulation 68 are satisfied. If the applicant desires to provide such services, it must complete the parts of the MCP application (i.e. those sections that have not been designated as applicable to insurers only) that are applicable to those services that it wishes to provide. If an insurer intends to employ an MCO that has been given the authority to provide such additional services, the insurer's application must specify the MCO(s) that will provide such services.

Insurers electing to offer managed care coverage must file for approval an appropriate discount that will be applicable to the Personal Injury Protection premium of those policies affording managed care coverage. A minimum discount of 5% must be provided and a higher discount will be approved if justified by the insurer.

This Circular Letter should be acknowledged in writing no later than September 1, 1995, to Ms. Hoda Nairooz, Senior Examiner, Property & Casualty Insurance Bureau, 160 West Broadway, New York, New York 10013. Please direct any questions concerning this Circular Letter to Ms. Nairooz (212-602-0334).