NAC695D.500. Establishment; scope; examination of system.

     1. Each organization that issues a policy in this State shall establish with the approval of the Commissioner a system for resolving any complaints of a member concerning services covered under the policy. In determining whether to approve a system for resolving complaints, the Commissioner will consult with the State Board of Health.

     2. A system for resolving complaints pursuant to subsection 1 must include an initial investigation, a review of the complaint by a review board and a procedure for appealing a determination regarding the complaint. The majority of the persons on a review board must be members who receive services pursuant to a policy issued by the organization.

     3. Each organization shall allow the Commissioner or the State Board of Health to examine the system for resolving complaints established pursuant to this section at such times as either deems necessary or appropriate.

     (Added to NAC by Comm’r of Insurance by R132-98, eff. 3-30-99)