Description of Internal Grievance and External Review Procedures; Inclusion With Materials Provided to Covered Persons.

Checkout our iOS App for a better way to browser and research.

Sec. 25.

(1) A health carrier shall include a description of the internal grievance and external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage, or other evidence of coverage it provides to covered persons.

(2) The description under subsection (1) must include all of the following:

(a) A statement informing the covered person of his or her right to file a request for an internal grievance and external review of an adverse determination.

(b) The director's toll-free telephone number and address.

(c) A statement informing the covered person that, when filing a request for an external review, the covered person will be required to authorize the release of any medical records that may be required to be reviewed to reach a decision on the external review.

History: 2000, Act 251, Eff. Oct. 1, 2000 ;-- Am. 2016, Act 274, Eff. Sept. 29, 2016


Download our app to see the most-to-date content.