40-4606.Same; health insurer required to inform in writing current andprospective insureds of availability of certain information.Every health insurer shall inform in writing current andprospective insureds that the following information shall be availableupon request:
(a) A complete description of the health care services, items and otherbenefits to which the insured is entitled in the particular healthbenefit plan which is covering or being offered to such person;
(b) a description of any limitations, exceptions or exclusions to coveragein the health benefit plan, including prior authorization policies, restricteddrug formularies or other provisions which restrict access to covered servicesor items by the insured;
(c) a listing of the health benefit plan's participating providers, theirbusiness addresses and telephone numbers, the availability of those providers,and any limitations on an insured's choice of provider;
(d) notification in advance of any changes in the health benefit plan whicheither reduces the coverage or benefits, or increases the cost, to such person;and
(e) a description of the grievance and appeal procedures available under thehealth benefit plan and an insured's rights regarding termination,disenrollment, nonrenewal or cancelation of coverage.
40-4606.Same; health insurer required to inform in writing current andprospective insureds of availability of certain information.Every health insurer shall inform in writing current andprospective insureds that the following information shall be availableupon request:
(a) A complete description of the health care services, items and otherbenefits to which the insured is entitled in the particular healthbenefit plan which is covering or being offered to such person;
(b) a description of any limitations, exceptions or exclusions to coveragein the health benefit plan, including prior authorization policies, restricteddrug formularies or other provisions which restrict access to covered servicesor items by the insured;
(c) a listing of the health benefit plan's participating providers, theirbusiness addresses and telephone numbers, the availability of those providers,and any limitations on an insured's choice of provider;
(d) notification in advance of any changes in the health benefit plan whicheither reduces the coverage or benefits, or increases the cost, to such person;and
(e) a description of the grievance and appeal procedures available under thehealth benefit plan and an insured's rights regarding termination,disenrollment, nonrenewal or cancelation of coverage.
40-4606.Same; health insurer required to inform in writing current andprospective insureds of availability of certain information.Every health insurer shall inform in writing current andprospective insureds that the following information shall be availableupon request:
(a) A complete description of the health care services, items and otherbenefits to which the insured is entitled in the particular healthbenefit plan which is covering or being offered to such person;
(b) a description of any limitations, exceptions or exclusions to coveragein the health benefit plan, including prior authorization policies, restricteddrug formularies or other provisions which restrict access to covered servicesor items by the insured;
(c) a listing of the health benefit plan's participating providers, theirbusiness addresses and telephone numbers, the availability of those providers,and any limitations on an insured's choice of provider;
(d) notification in advance of any changes in the health benefit plan whicheither reduces the coverage or benefits, or increases the cost, to such person;and
(e) a description of the grievance and appeal procedures available under thehealth benefit plan and an insured's rights regarding termination,disenrollment, nonrenewal or cancelation of coverage.
