1. (a) A health care insurer shall set out in, or attach to, a policy, certificate of coverage, membership booklet, or other evidence of coverage provided to a covered person by a health care insurer a clear and comprehensive description of the health care insurer's utilization review procedures. The description must include

   1. (1) the procedures for obtaining review of an adverse determination; and
   2. (2) a statement of rights and responsibilities of a covered person with respect to those procedures.
2. (b) A health care insurer shall include a summary of the health care insurer's utilization review and benefit determination procedures in the materials intended for a prospective covered person.
3. (c) A health care insurer's membership card must include a toll-free telephone number a covered person or the covered person's authorized representative may call for a utilization review and benefit decision.

(Eff. 3/15/2018, Register 225)

Authority: AS 21.06.090, AS 21.07.005