§432E-7  Information to enrollees.  (a) The managed care plan shall provide to its enrollees upon enrollment andthereafter upon request the following information:

(1)  A list of participating providers which shall beupdated on a regular basis indicating, at a minimum, their specialty andwhether the provider is accepting new patients;

(2)  A complete description of benefits, services, andcopayments;

(3)  A statement on enrollee's rights,responsibilities, and obligations;

(4)  An explanation of the referral process, if any;

(5)  Where services or benefits may be obtained;

(6)  Information on complaints and appeals procedures;and

(7)  The telephone number of the insurance division.

This information shall be provided to prospectiveenrollees upon request.

(b)  Every managed care plan shall provide tothe commissioner and its enrollees notice of any material change inparticipating provider agreements, services, or benefits, if the change affectsthe organization or operation of the managed care plan and the enrollee'sservices or benefits.  The managed care plan shall provide notice to enrolleesnot more than sixty days after the change in a format that makes the noticeclear and conspicuous so that it is readily noticeable by the enrollee.

(c)  A managed care plan shall provide genericparticipating provider contracts to enrollees, upon request. [L 1998, c 178, ptof §2; am L 1999, c 137, §7]