3 AAC 28.918 - Disclosure requirements

(a) A health care insurer shall set out in, or attach to, a policy, certificate of coverage, membership booklet, or other evidence of coverage provided to a covered person by a health care insurer a clear and comprehensive description of the health care insurer's utilization review procedures. The description must include

(1) the procedures for obtaining review of an adverse determination; and

(2) a statement of rights and responsibilities of a covered person with respect to those procedures.

(b) A health care insurer shall include a summary of the health care insurer's utilization review and benefit determination procedures in the materials intended for a prospective covered person.

(c) A health care insurer's membership card must include a toll-free telephone number a covered person or the covered person's authorized representative may call for a utilization review and benefit decision.

Notes

3 AAC 28.918

Eff. 3/15/2018,Register 225, April 2018

Authority:AS 21.06.090

AS 21.07.005