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(a)
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(1) Every health maintenance organization shall establish and maintain a complaint system that has been approved by the Insurance Commissioner to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning healthcare services.
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(2) Each health maintenance organization shall submit to the commissioner an annual report in a form prescribed by the commissioner that shall include:
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(A) A description of the procedures of the complaint system;
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(B) The total number of complaints handled through the complaint system and a compilation of causes underlying the complaints filed; and
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(C) The number, amount, and disposition of malpractice claims settled during the year by the health maintenance organization.
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(b)
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(1) The health maintenance organization shall maintain records of written complaints filed with it concerning issues and persons other than healthcare services and shall submit to the commissioner a summary report at such times and in such format as the commissioner may require.
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(2) Complaints involving other persons shall be referred to the persons with a copy to the commissioner.
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(c) The commissioner may examine the complaint system, subject to the limitation concerning medical records of individuals set forth in § 23-76-122(c).
