Section 41-5916 – DISCLOSURE REQUIREMENTS.
41-5916. DISCLOSURE REQUIREMENTS. (1) Each health carrier shall include a summary description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage or other evidence of coverage it provides to covered persons. The disclosure shall be in a format prescribed by the director. (2) The description required under […]
Section 41-5901 – SHORT TITLE.
41-5901. SHORT TITLE. This chapter shall be known and may be cited as the "Idaho Health Carrier External Review Act." History: [41-5901, added 2009, ch. 87, sec. 1, p. 240.]
Section 41-5917 – SEVERABILITY.
41-5917. SEVERABILITY. The provisions of this act are hereby declared to be severable and if any provision of this act or the application of such provision to any person or circumstance is declared invalid for any reason, such declaration shall not affect the validity of the remaining portions of this act. History: [41-5917, added 2009, […]
Section 41-5902 – PURPOSE AND INTENT.
41-5902. PURPOSE AND INTENT. The purpose of this chapter is to provide uniform standards for the establishment and maintenance of external review procedures to assure that covered persons have the opportunity for an independent review of a final adverse benefit determination, as defined in this chapter. History: [41-5902, added 2009, ch. 87, sec. 1, p. […]
Section 41-5903 – DEFINITIONS.
41-5903. DEFINITIONS. For purposes of this chapter: (1) "Administrative record" means all nonprivileged documents, records or other health information which was submitted, considered, generated or relied upon by the health carrier in the course of making the adverse benefit determination, including, but not limited to, documents, records or other information that constitutes the plan’s policy […]
Section 41-5904 – APPLICABILITY AND SCOPE.
41-5904. APPLICABILITY AND SCOPE. (1) Except as provided in subsection (2) of this section, this chapter shall apply to all health carriers. (2) The provisions of this chapter shall not apply to a plan, policy or certificate that provides coverage only for a specified disease, specified accident or accident-only coverage; nor shall this chapter apply […]
Section 41-5905 – NOTICE OF RIGHT TO EXTERNAL REVIEW.
41-5905. NOTICE OF RIGHT TO EXTERNAL REVIEW. (1) When a final adverse benefit determination is made, the health carrier shall notify the covered person in writing of the covered person’s right to request an external review to be conducted pursuant to section 41-5908, 41-5909 or 41-5910, Idaho Code, and include the appropriate statements and information […]