Grievances and certificate of compliance filed with the director,when.
376.1378. 1. A copy of the grievance procedures, including all formsused to process a grievance, shall be filed with the director. Any subsequentmaterial modifications to the documents also shall be filed. In addition, ahealth carrier shall file annually with the director, as part of its annualreport required by section 376.1375, a certificate of compliance stating thatthe health carrier has established and maintains, for each of its healthbenefit plans, grievance procedures that fully comply with the provisions ofsections 376.1350 to 376.1390. The director has authority to disapprove afiling that fails to comply with sections 376.1350 to 376.1390 or applicablerules and regulations.
2. A description of the grievance procedure shall be set forth in orattached to the policy, certificate, membership booklet, outline of coverageor other evidence of coverage provided to enrollees.
3. The grievance procedure documents shall include a statement of anenrollee's right to contact the director's office for assistance at any time.The statement shall include the toll-free telephone number and address of thedepartment of insurance, financial institutions and professional registration.
4. No such grievance procedure shall act as a bar to any suit in a courtof competent jurisdiction instituted by any such enrollee, or as a bar to anydefense thereto by the health carrier.
5. In the event there is a conflict between the outcomes of thegrievance procedure and any such suit, the outcome of the suit in a court ofcompetent jurisdiction shall prevail.
Grievances and certificate of compliance filed with the director,when.
376.1378. 1. A copy of the grievance procedures, including all formsused to process a grievance, shall be filed with the director. Any subsequentmaterial modifications to the documents also shall be filed. In addition, ahealth carrier shall file annually with the director, as part of its annualreport required by section 376.1375, a certificate of compliance stating thatthe health carrier has established and maintains, for each of its healthbenefit plans, grievance procedures that fully comply with the provisions ofsections 376.1350 to 376.1390. The director has authority to disapprove afiling that fails to comply with sections 376.1350 to 376.1390 or applicablerules and regulations.
2. A description of the grievance procedure shall be set forth in orattached to the policy, certificate, membership booklet, outline of coverageor other evidence of coverage provided to enrollees.
3. The grievance procedure documents shall include a statement of anenrollee's right to contact the director's office for assistance at any time.The statement shall include the toll-free telephone number and address of thedepartment of insurance, financial institutions and professional registration.
4. No such grievance procedure shall act as a bar to any suit in a courtof competent jurisdiction instituted by any such enrollee, or as a bar to anydefense thereto by the health carrier.
5. In the event there is a conflict between the outcomes of thegrievance procedure and any such suit, the outcome of the suit in a court ofcompetent jurisdiction shall prevail.
Grievances and certificate of compliance filed with the director,when.
376.1378. 1. A copy of the grievance procedures, including all formsused to process a grievance, shall be filed with the director. Any subsequentmaterial modifications to the documents also shall be filed. In addition, ahealth carrier shall file annually with the director, as part of its annualreport required by section 376.1375, a certificate of compliance stating thatthe health carrier has established and maintains, for each of its healthbenefit plans, grievance procedures that fully comply with the provisions ofsections 376.1350 to 376.1390. The director has authority to disapprove afiling that fails to comply with sections 376.1350 to 376.1390 or applicablerules and regulations.
2. A description of the grievance procedure shall be set forth in orattached to the policy, certificate, membership booklet, outline of coverageor other evidence of coverage provided to enrollees.
3. The grievance procedure documents shall include a statement of anenrollee's right to contact the director's office for assistance at any time.The statement shall include the toll-free telephone number and address of thedepartment of insurance, financial institutions and professional registration.
4. No such grievance procedure shall act as a bar to any suit in a courtof competent jurisdiction instituted by any such enrollee, or as a bar to anydefense thereto by the health carrier.
5. In the event there is a conflict between the outcomes of thegrievance procedure and any such suit, the outcome of the suit in a court ofcompetent jurisdiction shall prevail.
