US Laws, Codes, Statutes & Cases

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 39
                             MANAGED CARE REFORM
    41-3914.  ANNUAL DISCLOSURES. (1) Every managed care organization shall
provide to its enrollees and make available for inspection by the general
public on an annual basis:
    (a)  an audited statement of financial condition including a balance sheet
    and a summary of receipts and disbursements;
    (b)  a description of the accessibility and availability of services,
    including a list of the providers currently participating in the managed
    care plan and of the providers who are accepting new patients, the
    addresses of primary care physicians and participating hospitals and the
    specialty of each physician and category of the other participating
    providers;
    (c)  a statement as to whether the plan includes a limited formulary of
    medications, and  a statement that the formulary will be made available to
    any prospective member or member upon request;
    (d)  a clear and understandable description of the managed care
    organization's method of resolving member grievances;
    (e)  a description of how the qualifications of participating providers
    may be obtained;
    (f)  such other information as the director may by rule prescribe.
    (2)  In addition to matters specified in subsection (1) of this section,
each managed care organization shall make available for public inspection a
description of the benefit package or packages offered to each class of
members and their rates. Such information shall be presented in clear,
readable, and concise form and shall include, at a minimum, a description of
all of the material elements required of health care contracts.
    (3)  A managed care organization for which a certificate of authority is
required shall furnish a copy of the information required by this section  to
the department.