514B.14 Complaint system.
1. A health maintenance organization shall establish and maintain a complaint system which has been approved by the commissioner and which shall provide for the resolution of written complaints initiated by enrollees concerning health care services. A health maintenance organization shall submit to the commissioner an annual report in a form prescribed by the commissioner which shall include:
a. A description of the procedures of the complaint system.
b. The total number of complaints handled through the complaint system and a compilation of causes underlying the complaints filed.
c. The number, amount and disposition of malpractice claims settled during the year by the health maintenance organization and any of its providers.
2. The health maintenance organization shall maintain statistical information of written complaints filed with it concerning benefits over which the health maintenance organization does not have control and shall submit to the commissioner a summary report at the time and in the format that the commissioner may require. Complaints involving other persons shall be referred to those persons and a copy of the complaint sent to the commissioner.
[C75, 77, 79, 81, §514B.14]
92 Acts, ch 1162, §26; 2012 Acts, ch 1023, §157
Referred to in §514B.3
Structure Iowa Code
Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS
Section 514B.1 - Definitions — services required or available.
Section 514B.2 - Establishment of health maintenance organizations.
Section 514B.3 - Application for a certificate of authority.
Section 514B.3A - Articles — approval — bylaws.
Section 514B.3B - Certificate of authority — renewal.
Section 514B.4 - Applicant for certificate of authority.
Section 514B.4A - Direct provision of health care services.
Section 514B.5 - Issuance and denial of a certificate of authority.
Section 514B.6 - Powers of health maintenance organizations.
Section 514B.7 - Governing body.
Section 514B.8 - Fiduciary responsibilities.
Section 514B.9 - Evidence of coverage.
Section 514B.9A - Coverage of children — continuation or reenrollment.
Section 514B.11 - Disapproval of filings.
Section 514B.12 - Annual report.
Section 514B.13 - Open enrollment.
Section 514B.14 - Complaint system.
Section 514B.15 - Investments.
Section 514B.16 - Protection against insolvency.
Section 514B.17 - Cancellation of enrollees.
Section 514B.17A - Rescission.
Section 514B.18 - False representation.
Section 514B.19 - Regulation of insurance producers.
Section 514B.20 - Powers of insurers and hospital and medical service corporations.
Section 514B.21 - Public employees included.
Section 514B.24 - Examinations permitted.
Section 514B.25 - Financially impaired or insolvent health maintenance organizations.
Section 514B.25A - Impairment and insolvency protection.
Section 514B.26 - Administrative procedures.
Section 514B.27 - Judicial review.
Section 514B.30 - Communications in professional confidence.
Section 514B.32 - Construction.
Section 514B.33 - Establishment of limited service organizations.