If an insurer denies a member or member representative’s appeal of a rescission, the insurer shall provide the member or member representative and the Department of Insurance, Securities, and Banking with a written explanation of why the insurer found that there was fraud or misrepresentation of a material fact. The notice shall explain the member’s right to appeal to the Department of Insurance, Securities, and Banking.
(Apr. 27, 1999, D.C. Law 12-274, § 106a; as added Mar. 19, 2013, D.C. Law 19-229, § 2(f), 59 DCR 13592.)
The 2013 amendment by D.C. Law 19-229 added this section.
Structure District of Columbia Code
Title 44 - Charitable and Curative Institutions
Chapter 3 - Grievance Procedures for Health Benefits Plans
Subchapter I - Grievance and Appeals Procedure
§ 44–301.02. Medicare not applicable
§ 44–301.03. Establishment of grievance system
§ 44–301.04. Grievance process
§ 44–301.05. Informal internal review. [Repealed]
§ 44–301.06. Internal appeals process
§ 44–301.06a. Appeals of rescissions to the Department of Insurance, Securities, and Banking
§ 44–301.07. External appeals process for matters other than rescissions
§ 44–301.08. Certification and general requirements for independent review organizations
§ 44–301.09. Assessment of insurers
§ 44–301.10. Reporting requirements
§ 44–301.11. Availability of District external review procedures for self-insured plans