1. (a) A health care insurer shall maintain a written calendar year register, in a manner that is reasonably clear and accessible to the director, to document

   1. (1) each grievance received;
   2. (2) a general description of the reason for the grievance;
   3. (3) the date the grievance was received;
   4. (4) the date of each review;
   5. (5) resolution of the grievance;
   6. (6) the date of resolution;
   7. (7) the name of the covered person for whom the grievance was filed;
   8. (8) the health care insurer's review of each grievance;
   9. (9) notices and claims associated with each grievance;
   10. (10) each request for a review of a grievance involving an adverse determination; and
   11. (11) evidence sufficient to document compliance with this section.

2. (b) A health care insurer shall make the records maintained under (a) of this section available to the following upon request:

   1. (1) the covered person or the covered person's authorized representative;
   2. (2) the director;
   3. (3) an applicable federal oversight agency.

3. (c) Except under (d) of this section, a health care insurer shall retain a calendar year register for the longer of the following periods:

   1. (1) three years; or
   2. (2) until the director has adopted a final report of an examination that contains a review of the register for that calendar year.
4. (d) Notwithstanding (c) of this section, a health care insurer shall retain for six years calendar year register records of a claim filed, and notice provided, under 3 AAC 28.936(o) and 3 AAC 28.938(h).

5. (e) A health care insurer shall submit to the director a calendar year annual report in a format approved by the director. The report must include for each type of health care insurance policy offered by the health care insurer

   1. (1) a certificate of compliance stating the health care insurer has established and maintains, for each health care insurance policy, grievance procedures that fully comply with 3 AAC 28.930 - 3 AAC 28.938;
   2. (2) the number of covered lives;
   3. (3) the total number of grievances;
   4. (4) the number of grievances resolved and their resolution;
   5. (5) the number of grievances appealed to the director of which the health care insurer is aware;
   6. (6) the number of grievances referred to alternative dispute resolution procedures or resulting in litigation; and
   7. (7) a synopsis of actions being taken by the health care insurer to correct problems identified by the health care insurer or the division during a grievance.

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

Authority: AS 21.06.090, AS 21.07.005