Sec. 4. A health maintenance organization shall provide to each enrollee and subscriber:
(1) information on:
(A) how services can be obtained;
(B) where additional information on access to services can be obtained;
(C) how to file a grievance under IC 27-13-10 and IC 27-13-10.1;
(D) the health maintenance organization's:
(i) structure;
(ii) health care benefits and exclusions; and
(iii) criteria for denying coverage; and
(E) costs for which the enrollee or subscriber is responsible; and
(2) a toll free telephone number through which the enrollee can contact the health maintenance organization at no cost to the enrollee to obtain information and to file grievances.
The information under this section must be provided to a potential enrollee of the health maintenance organization upon request.
As added by P.L.26-1994, SEC.25. Amended by P.L.191-1997, SEC.3; P.L.69-1998, SEC.8; P.L.133-1999, SEC.4.
Structure Indiana Code
Article 13. Health Maintenance Organizations
Chapter 9. Information to Enrollees or Subscribers
27-13-9-2. Notice of Change in Operation of Health Maintenance Organization
27-13-9-3. Termination of Provider
27-13-9-4. Information on Services and Filing Grievances; Telephone Number
27-13-9-5. Prescription Drug Information Card
27-13-9-6. "Health Plan Information Card"; Indication of Benefits and Health Care Services
27-13-9-7. Electronic Data Base Requirements; Rulemaking Authority