W. Va. Code R. § 114-95-11

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114-95-11 - Disclosure Requirements

11.1. In the certificate of coverage or member handbook provided to covered persons, an issuer shall include a clear and comprehensive description of its utilization review procedures, including the procedures for obtaining review of adverse determinations, and a statement of rights and responsibilities of covered persons with respect to those procedures.

11.2. An issuer shall include a summary of its utilization review and benefit determination procedures in materials intended for prospective covered persons.

11.3. An issuer shall print on its membership cards a toll-free telephone number to call for utilization review and benefit decisions.

W. Va. Code R. § 114-95-11