| (a) QTL and NQTL templates.
(1) For purposes of this division, "QTL template" is
the template titled "Compliance Analysis for Quantitative Parity"
and its associated technical instructions, available on TDI's website.
(2) For purposes of this division, "NQTL template"
is the template titled Compliance Analysis for Nonquantitative Parity"
and its associated technical instructions, available on TDI's website.
(b) Analyses of quantitative and nonquantitative parity.
(1) An issuer must analyze each health benefit plan
to determine whether its plan design complies with the quantitative
parity requirements in §§21.2433 - 21.2437 of this title
(relating to Compliance Analysis for Quantitative Parity: General
Requirements, Quantitative Parity Analysis: Issuer and Plan Information,
Quantitative Parity Analysis: Methodology for Determining Expected
Payments, Quantitative Parity Analysis: Covered Benefits, and Quantitative
Parity Analysis: "Substantially All" and "Predominant" Tests), using
the QTL template, except as permitted by subsection (c) of this section.
(2) An issuer must analyze each health benefit plan
to determine whether its plan design complies with the nonquantitative
parity requirements in §§21.2438 - 21.2441 of this title
(relating to Compliance Analysis for Nonquantitative Parity: General
Instructions, Nonquantitative Treatment Limitations Generally, Nonquantitative
Parity Analysis: Issuer and Plan Information, and Four-Step Analysis
of Nonquantitative Treatment Limitations), using the NQTL template,
except as permitted by subsection (d) of this section.
(c) Alternative tool for quantitative parity analysis.
An issuer may use an alternative quantitative parity analysis tool
instead of the QTL template if the issuer demonstrates to TDI's satisfaction
that it is using a methodology for the "predominant" and "substantially
all" tests that is consistent with §21.2408 of this title (relating
to Parity Requirements with Respect to Financial Requirements and
Treatment Limitations).
(1) Upon request by TDI, an issuer must produce documentation
that provides the same level of specificity as the QTL template.
(2) TDI will assess whether the alternative compliance
tool satisfies the requirements of this section at the time TDI requests
that the issuer submit its compliance analysis.
(d) Alternative tool for nonquantitative parity analysis.
An issuer may use an alternative tool instead of the NQTL template
if the issuer demonstrates to TDI's satisfaction that the alternative
tool contains the information required for each step of the four-step
process stated in §21.2441 of this title.
(1) Upon request by TDI, an issuer must produce documentation
that provides the same level of specificity as the NQTL template.
(2) TDI will assess whether the alternative tool satisfies
the requirements of this section at the time TDI requests that the
issuer submit its compliance analysis.
|
