Conn. Agencies Regs. § 38a-591-8 - Notice to enrollees
(a) Each health
carrier that submits notices to a covered person or the covered person's
authorized representative pursuant to section
38a-591d
of the Connecticut General Statutes, including adverse determinations that
involve a rescission, shall include with the Notice of Adverse Determination a
description of the health carrier's procedures for initiating an internal
grievance of an adverse determination including the procedures for requesting
an expedited review. Such notification shall also include the procedures for
filing an external review and an expedited external review.
(b) Each health carrier that submits a notice
to a covered person or the covered person's authorized representative pursuant
to section
38a-591e
of the Connecticut General Statutes shall include with the Notice of a
Grievance Decision that upholds the adverse determination a description of the
health carrier's procedures for initiating any remaining internal grievance
rights including the procedures for requesting an expedited review. If the
Notice of a Grievance Decision that upholds the adverse determination is the
final adverse determination, or if the notice is issued due to the health
carrier's failure to strictly adhere to the requirements of section
38a-591e(f)(1)
of the Connecticut General Statutes, the notice shall also include a statement
that all internal appeals have been exhausted. Such notice shall include the
procedure for filing an external review and an expedited external review, as
well as a copy of the external review application and a consumer guide to the
external review process. The commissioner shall develop and make available to
health carriers the external review application and consumer guide to the
external review process. A copy of the external review application and consumer
guide shall also be made available from the health carrier to a covered person
or the covered person's authorized representative, upon request.
(c) For purposes of triggering the filing
period for an external review request or an expedited external review request
under section
38a-591g(e)
of the Connecticut General Statutes, notice of an adverse determination or a
final adverse determination shall be deemed to have been received by the
covered person or the covered person's authorized representative five (5)
calendar days after the notice is mailed.
Notes
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