Sec. 1271.054. INFORMATION ABOUT COMPLAINTS AND APPEALS. (a) An evidence of coverage must contain a clear and understandable description of the health maintenance organization's methods for resolving enrollee complaints, including:
(1) the enrollee's right to appeal denial of an adverse determination to an independent review organization; and
(2) the procedures for appealing to an independent review organization.
(b) A health maintenance organization may indicate a subsequent change to the methods for resolving enrollee complaints in a separate document issued to the enrollee.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges
Subchapter B. Contents of Evidence of Coverage
Section 1271.051. Evidence of Coverage: Contract and Certificate Requirements
Section 1271.052. Information About Benefits and Limitations
Section 1271.053. Information About Obtaining Services
Section 1271.054. Information About Complaints and Appeals
Section 1271.055. Out-of-Network Services
Section 1271.056. Unfair or Deceptive Provisions and Statements Prohibited