Licensing & Renewal Requirements For Utilization Review Companies (This Bulletin rescinded and replaced by Bulletin HC-86-16 )

CT state seal STATE OF CONNECTICUT INSURANCE DEPARTMENT BULLETIN HC-86-15 JULY 8, 2015 TO: UTILIZATION REVIEW COMPANIES RE: LICENSING & RENEWAL REQUIREMENTS FOR UTILIZATION REVIEW COMPANIES This bulletin supersedes Bulletin HC-86-14 dated July 21,2014. Utilization review licenses must be renewed each October 1 regardless of the date of initial licensure. The license application is available on the Insurance Department website (www.ct.gov/cid) under the tab "Forms and Applications." Applications may also be requested from the Life & Health Division at the address listed below . Note that there is an additional survey item that is part of the application form . Conn. Gen. Stat. §38a­ 591d(e)(1)(F) requires that the notice of adverse determination include a link providing the criterion used in the determination. The Insurance Department previously relied on the company's certification of compliance. Despite certifying compliance, review of such links has revealed that the information on the criterion was not always sufficient and in keeping with the intent of the law. As such, all companies must provide the additional documentation and sample criterion requested in the survey for licensure on and after October 1, 2015. When first applying for a utilization review license, companies should ensure that the application is complete with all necessary supporting materials. The application and all supporting materials including letters to enrollees should be specific to Connecticut for plans that are fully insured . Any application that contains provisions regarding jurisdictions outside of Connecticut or for self-funded plans will be rejected. Applications will not be considered until all required information is submitted. The license fee should not be sent with the application. Companies renewing October 1, 2015 should review relevant laws, Connecticut Insurance Department Bulletins and the current license application posted on the website . For renewals effective on or after October 1,20 IS, the survey and certification (Attachments 1 and 2) that are attached to the application must be filed as part of the renewal application in addition to any other changes or updates to the previously submitted application. The license fee should not be sent with the application for renewal. Upon satisfactory review of the application, the Insurance Department will invoice the company. The license will be issued upon receipt of the $3,000 license fee. All checks must be made payable to the Treasurer - State of Connecticut. License fees are not prorated for partial years. Utilization review companies are reminded that any material change in information supplied in an application for licensure or renewal must be filed with the Insurance Department within 30 calendar days after such change. QUESTIONS Please contact the In,surance Department Life and Health Division at cid.lh@ ct.gov with any questions. Insurance Commissioner's signature Katharine 1. Wade Insurance Commissioner www.ct.gov/cid P.O. Box 816 • Hartford.CT06142-0816 An Equal Opportunity Employer