Authority: IC 27-8-28-20; IC 27-13-10-13; IC 27-13-35-1

Affected: IC 27-8-28; IC 27-13-10-3

Sec. 5. (a) An insurer, a health maintenance organization, and a limited service health maintenance organization shall maintain written records that document certain information about all grievances received during a calendar year (the grievance register).

(b) The grievance register shall contain, at a minimum, the following information for each grievance:

1. (1) A general description of the basis for the grievance using the categories in block 3 of the grievance procedures report set forth in section 14 of this rule.
2. (2) Date received.
3. (3) Date investigated or reviewed.
4. (4) Date resolved.
5. (5) Description of resolution.
6. (6) Date appeal, if any, was received.
7. (7) Date of appeals hearing or review.
8. (8) Date appeal was resolved.
9. (9) Description of resolution of the appeal.
10. (10) Name of enrollee and enrollee's representative, if any, who filed, or upon whose behalf was filed, the grievance.
11. (11) Names and titles of all persons who investigated, reviewed, and resolved the grievance.

(c) An insurer, a health maintenance organization, or a limited service health maintenance organization shall retain each grievance register until the commissioner has conducted an examination of the organization and adopted a final report of the examination that contains a review of the register for the calendar year covered by the grievance register.

(Department of Insurance; 760 IAC 1-59-5; filed Sep 30, 1998, 2:17 p.m.: 22 IR 447, eff Jan 1, 1999; filed Feb 17, 2003, 9:57 a.m.: 26 IR 2327; readopted filed Nov 24, 2009, 9:35 a.m.: 20091223-IR-760090791RFA; readopted filed Nov 20, 2015, 9:25 a.m.: 20151216-IR-760150341RFA; readopted filed Nov 15, 2021, 8:32 a.m.: 20211215-IR-760210419RFA; readopted filed Oct 22, 2025, 3:17 p.m.: 20251119-IR-760240637RFA)