Sec. 1271.054. INFORMATION ABOUT COMPLAINTS AND APPEALS. (a) An evidence of coverage must contain a clear and understandable description of the health maintenance organization's methods for resolving enrollee complaints, including:
(1) the enrollee's right to appeal denial of an adverse determination to an independent review organization; and
(2) the procedures for appealing to an independent review organization.
(b) A health maintenance organization may indicate a subsequent change to the methods for resolving enrollee complaints in a separate document issued to the enrollee.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Section: Previous 1271.004 1271.005 1271.006 1271.007 1271.051 1271.052 1271.053 1271.054 1271.055 1271.056 1271.057 1271.101 1271.102 1271.103 1271.104 NextLast modified: September 28, 2016