State Codes and Statutes

Statutes > New-jersey > Title-26 > Section-26-2j > 26-2j-12

26:2J-12.  Complaint system    a.  (1) Every health maintenance organization shall establish and maintain a  complaint system to provide reasonable procedures for the resolution of written  complaints initiated by enrollees concerning health care services.

    (2) Each health maintenance organization shall submit to the commissioner an  annual report in a form prescribed by him which shall include:

    (a) a description of the procedures of such complaint system;

     (b) the total number of written complaints handled through such complaint system and a compilation of causes underlying the complaints filed;  and

     (c) the number, amount, and disposition of malpractice claims settled during  the year by the health maintenance organization and any of the providers used  by it.

    b.  The health maintenance organization shall maintain records of written complaints filed with it concerning other than health care services and shall submit to the commissioner a summary report at such times and in such format as  the commissioner may require.

    c.  The commissioner may examine such complaint system.

     L.1973, c. 337, s. 12, eff. Dec. 27, 1973.