Licensing Requirements for Utilization Review Companies

STATE OF CONNECT CUT INSURANCE DEPARTMENT Bulletin HC-86 July 19,2011 TO: ENTITIES REQUIRED TO BE LICENSED AS UTILIZATION REVIEW COMPANIES RE: LICENSING REQUIREMENTS This bulletin supersedes Bulletin HC-48 (Rev.) dated June 9, 1994. Section 63 of Connecticut Public Act 11-58 (the "Act"), effective July I, 20 II, requires that any entity performing utilization review in Connecticut for a health benefit plan under the jurisdiction of the Insurance Commissioner ("Commissioner") be licensed by the Commissioner. Pursuant to this Act, the categories of what entities must be licensed to perform utilization review in Connecticut have changed from the entities required under prior statutes. A health benefit plan is defined in section 54 of the Act as an insurance policy or contract, certificate or agreement offered, delivered, issued for del ivery, renewed, amended or continued in this state to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services. A number of entities formerly requiring licensing no longer are required to be Jicensed. Utilization review companies should review section 54 of the Act to determine if they are required to be licensed pursuant to the Act. Utilization review companies should be sure that each application is complete with all necessary supporting materials. Applications will not be considered until all required information is submitted. Upon satisfactory review of the application, the company will be notified that a license will be issued upon receipt of the $3000 license fee. All checks must be made payable to the Treasurer - State of Connecticut. License fees are not prorated. Utilization review licenses must be renewed annually each October I. Utilization review companies should also note that any material change in the information supplied in a request for licensure or renewal must be filed with the Depaltment within 30 calendar days after the change. License applications are available on the Insurance Department web site: www.ct.gov/cid. Questions should be directed to the attention of the Life and Health Division at cid.lh@ct. 'ov. Insurance Commissioner www.ct.gov/cid P.O. Box 816 • Hartford, CT 06142-0816 An Equal Opportunity Employer