NAC695F.600. Establishment; scope; examination of system.

     1. Each organization that issues an evidence of coverage in this State shall establish with the approval of the Commissioner a system for resolving any complaints of an enrollee concerning limited health services covered under the evidence of coverage. 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 members on a review board must be enrollees who receive limited health services pursuant to an evidence of coverage 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)