Section 65-6 - Policy Requirements (a) Network Adequacy - (i) Pursuant to W.S. 26-18-302(a)(vii), the Wyoming insurance commissioner shall review any provider network requirements in the out-of-state health insurance policy and may require modification of those requirements if the policy lacks sufficient network providers in Wyoming.
- (ii) Provider networks are sufficient so long as:
- (A) The insurer maintains a network that is sufficient in number and types of providers in Wyoming so as to assure that all services will be accessible without unreasonable delay as proven by submitting a network provider list to the Wyoming Department of Insurance; and
- (B) The network has at least thirty percent (30%) of available essential community providers in the polices service area. A network that has at least five percent (5%) of available essential community providers in the polices service area may be considered sufficient so long as the insurer includes as part of its application a satisfactory narrative describing how the insurers provider network(s), as currently designed, provides an adequate level of service for low-income and medically underserved enrollees.
- (iii) If the insurer has insufficient number or type of participating providers to provide a covered benefit, the insurer shall ensure that the covered person obtains the covered benefit at no greater cost to the covered person than if the benefit were obtained from participating providers, or shall make arrangements acceptable to the Wyoming insurance commissioner.
- (iv) The insurer shall include a provider directory with the application form. The directory must at a minimum list providers specialties, locations of providers, acceptance of new patient status, the total unduplicated providers, and the total number of essential community providers in the provider network. The Wyoming insurance commissioner can require that more categories of disclosure be included in the provider directory. The Wyoming insurance commissioner may terminate the insurers ability to issue out-of-state health insurance policies in Wyoming should the network fail to meet the network adequacy standards set forth in this regulation.
- (v) The insurer shall give the Wyoming insurance commissioner prompt notice of a potential loss of a material provider. Upon such notice the Wyoming insurance commissioner has the authority to initiate an interim network adequacy review.
- (vi) Should the state of Wyoming adopt statutory standards for network adequacy for health insurance policies sold in Wyoming, those statutory provisions will preempt this regulatory guidance on network adequacy. Policies sold pursuant to W.S. W.S. 26-18-301, et seq. will then be required to meet the statutory standards for network adequacy.
044-65 Wyo. Code R. § 65-6