44-5427. Description of review procedures; toll-free number.
(1) In the certificate of coverage or member handbook provided to covered persons, a health carrier shall include a clear and comprehensive description of its utilization review procedures, including the procedures for obtaining review of adverse determinations, and a statement of rights and responsibilities of covered persons with respect to those procedures.
(2) A health carrier shall include a summary of its utilization review procedures in enrollment materials intended for prospective covered persons.
(3) A health carrier shall print on its membership cards a toll-free telephone number to call for utilization review decisions.
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