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Update From HEALTH on UnitedHealthcare/Care New England Contract

As of December 21, 2010, UnitedHealthcare (United) and Care New England Health System (CNE) have not reached an agreement on their contract that is scheduled to expire on December 31, 2010.

If United and CNE do not reach an agreement by December 31, 2010, patients will still be able to use CNE providers and facilities until the Rhode Island Department of Health (HEALTH) makes a final decision on United’s material modification application. United has agreed to clarify this in a letter to all members.

Any time a health insurer anticipates a significant network change offered in its health plan (such as a hospital dropping from its plan), the insurer must apply to HEALTH for approval of the material modification. Upon receipt of an application, HEALTH must review it for completeness. Once an application has been deemed complete, HEALTH has 90 days to take action and up to 30 days to post a notice for public comment. The public then has 10 days from the date of the public notice to submit written comments to HEALTH. HEALTH can only take final action on an application once the public comment period has ended.

United has submitted an application to HEALTH; however, the application has not been deemed complete. Therefore, there is not enough time in the 2010 calendar year for HEALTH to review and act upon the application before the current contract expires. Because HEALTH has not approved the material modification application, United must continue to provide the same seamless access to CNE providers for all of its members.

HEALTH will post any updated information on its website at ###

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