§432E-7 Information to enrollees.
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§432E-7 Information to enrollees.
(a)The managed care plan shall provide to its enrollees upon enrollment and thereafter upon request the following information:
(1)A list of participating providers which shall be updated on a regular basis indicating, at a minimum, their specialty and whether the provider is accepting new patients;
(2)A complete description of benefits, services, and copayments;
(3)A statement on enrollee's rights, responsibilities, and obligations;
(4)An explanation of the referral process, if any;
(5)Where services or benefits may be obtained;
(6)Information on complaints and appeals procedures; and
(7)The telephone number of the insurance division.
This information shall be provided to prospective enrollees upon request.
(b)Every managed care plan shall provide to the commissioner and its enrollees notice of any material change in participating provider agreements, services, or benefits, if the change affects the organization or operation of the managed care plan and the enrollee's services or benefits. The managed care plan shall provide notice to enrollees not more than sixty days after the change in a format that makes the notice clear and conspicuous so that it is readily noticeable by the enrollee.
(c)A managed care plan shall provide generic participating provider contracts to enrollees, upon request. [L 1998, c 178, pt of §2; am L 1999, c 137, §7]