(1) An insurer of a health benefit plan shall include in the plan the following statements, in boldfaced type or otherwise emphasized:
(a) A statement of the right of enrollees to apply for external review by an independent review organization; and
(b) A statement of whether the insurer agrees to be bound by decisions of independent review organizations.
(2) If an insurer states in the health benefit plan as provided in subsection (1) of this section that the insurer is not bound by the decisions of independent review organizations, the plan and the written information provided by the plan must prominently disclose that:
(a) The insurer is not bound by the decisions of independent review organizations;
(b) The insurer may follow nonetheless a decision by an independent review organization; and
(c) If the insurer does not follow a decision of an independent review organization, the enrollee has the right to sue the insurer.
(3) If an insurer states in the health benefit plan as provided in subsection (1) of this section that the insurer is bound by the decisions of independent review organizations, the plan must prominently disclose that fact. The plan must also state that the insurer agrees to act in accordance with the decision of the independent review organization notwithstanding the definition of medical necessity in the plan. [2001 c.266 §10]
Section: Previous 743.852 743.853 743.854 743.855 743.856 743.857 743.858 743.859 743.860 743.861 743.862 743.863 743.864 743.865 743.866 NextLast modified: August 7, 2008