Effective 28 Aug 1997
354.558. Materials provided to prospective purchasers. — A community-based health maintenance organization shall provide each prospective purchaser of its services with the following marketing materials prior to enrollment:
(1) A list of the health care providers who have a contractual agreement to provide services under the plan of coverage. It shall be a violation of the unfair trade practices act for a community-based health maintenance organization to falsely list that a provider has a contractual agreement to provide services under its plan of coverage;
(2) Information to describe how the community-based health maintenance organization will use utilization management to promote efficiency in the delivery of services in accordance with the terms of the contract for coverage. This information shall explain how the community-based health maintenance organization will encourage the use of treatment options that produce the most cost-effective results. The format and content of the descriptive information disclosed under this subdivision shall be approved by the department of commerce and insurance and shall include information regarding covered benefits available under the plan;
(3) Disclosure of grievance procedures established in accordance with regulations promulgated by the department of commerce and insurance for community-based health maintenance organizations. Included in this information shall be notification of how and when to contact the health plan and the department of commerce and insurance regarding a grievance; and
(4) Notice of the availability of coverage as described in section 354.554.
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(L. 1997 H.B. 335 § 4)
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