58-17H-33 Information required to be provided to covered persons and prospective covered persons.
Information required to be provided to covered persons and prospective covered
In the certificate of coverage or member handbook provided to covered persons, a health
carrier shall include a clear and comprehensive description of its utilization review procedures,
including the procedures for obtaining review of adverse determinations, and a statement of rights
and responsibilities of covered persons with respect to those procedures. A health carrier shall
include a summary of its utilization review and benefit determination procedures in materials
intended for prospective covered persons. A health carrier shall print on its membership cards a toll-free telephone number to call for utilization review and benefit decisions. (SL 2012, ch 239, § 1
provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the
Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended
by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029
(2010) is found to be unconstitutional in its entirety by a final decision of a federal court of
competent jurisdiction and all appeals exhausted or time for appeals elapsed.")
Source: SL 2011, ch 219, § 58.