TITLE 41

INSURANCE

CHAPTER 39

MANAGED CARE REFORM

41-3914.  Annual disclosures. (1) Every managed care organization shall provide to its enrollees and make available for inspection by the general public on an annual basis:

(a)  an audited statement of financial condition including a balance sheet and a summary of receipts and disbursements;

(b)  a description of the accessibility and availability of services, including a list of the providers currently participating in the managed care plan and of the providers who are accepting new patients, the addresses of primary care physicians and participating hospitals and the specialty of each physician and category of the other participating providers;

(c)  a statement as to whether the plan includes a limited formulary of medications, and a statement that the formulary will be made available to any prospective member or member upon request;

(d)  a clear and understandable description of the managed care organization’s method of resolving member grievances;

(e)  a description of how the qualifications of participating providers may be obtained;

(f)  such other information as the director may by rule prescribe.

(2)  In addition to matters specified in subsection (1) of this section, each managed care organization shall make available for public inspection a description of the benefit package or packages offered to each class of members and their rates. Such information shall be presented in clear, readable, and concise form and shall include, at a minimum, a description of all of the material elements required of health care contracts.

(3)  A managed care organization for which a certificate of authority is required shall furnish a copy of the information required by this section to the department upon request of the director.

History:

[41-3914, added 1974, ch. 177, sec. 14, p. 1444; am. 1978, ch. 360, sec. 1, p. 947; am. 1997, ch. 204, sec. 16, p. 590; am. 2008, ch. 203, sec. 3, p. 653.]