2014 Minnesota Statutes
Chapters 59A - 79A — INSURANCE
Chapter 62Q — HEALTH PLAN COMPANIES
Section 62Q.731 — EXTERNAL REVIEW OF ADVERSE DETERMINATION.

62Q.731 EXTERNAL REVIEW OF ADVERSE DETERMINATION. § Subdivision 1. Definitions.

(a) For purposes of this section, the terms defined in this subdivision have the meanings given.

(b) "Enrollee" means an eligible person as defined in section 62E.02, subdivision 13, and who meets the eligibility criteria established in section 62E.14.

(c) "Board" means the board of directors of the Comprehensive Health Association, as described in section 62E.10, subdivision 2.

§ Subd. 2. Appeal to external review entity.

If an enrollee receives an adverse determination as a result of the Comprehensive Health Association's internal appeal process, by which an established enrollee appeal committee renders an adverse determination, the enrollee then has the option of:

(1) appealing the adverse determination to the external review entity under section 62Q.73, which shall constitute a final determination subject to the conditions specified in section 62Q.73; or

(2) appealing to the commissioner of commerce from an adverse determination as provided by the operating rules of the Comprehensive Health Association, in which case the commissioner has the option of making a determination regarding the appeal, or submitting the appeal to the external review entity retained under section 62Q.73.

History:

2002 c 330 s 29

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