38.2-5803 - Disclosures and representations to enrollees.
§ 38.2-5803. Disclosures and representations to enrollees.
A. The following shall be provided to the MCHIP's covered persons at the timeof enrollment or at the time the contract or evidence of coverage is issuedand shall be made available upon request or at least annually:
1. A list of the names and locations of all affiliated providers. Such listmay be made available in a form other than a printed document, provided thepurchaser or existing enrollee is given the means to request and receive aprinted copy of such list.
2. A description of the service area or areas within which the MCHIP shallprovide health care services.
3. A description of the method of resolving complaints of covered persons,including a description of any arbitration procedure if complaints may beresolved through a specified arbitration agreement.
4. Notice that the MCHIP is subject to regulation in the Commonwealth by boththe State Corporation Commission Bureau of Insurance pursuant to Title 38.2and the Virginia Department of Health pursuant to Title 32.1.
5. A prominent notice included within the evidence of coverage, providingsubstantially the following: "If you have any questions regarding an appealor grievance concerning the health care services that you have been providedthat have not been satisfactorily addressed by your plan, you may contact theOffice of the Managed Care Ombudsman for assistance." Such notice shall alsoprovide the toll-free telephone number, mailing address, and electronic mailaddress of the Office of the Managed Care Ombudsman. This section shall notapply to evidences of coverage for enrollees in the plans administered by theDepartment of Medical Assistance Services that provide benefits pursuant toTitle XIX or Title XXI of the Social Security Act, as amended.
B. The following shall apply to MCHIPs that require a covered person toselect a primary care physician with respect to the offer of basic healthcare services by the MCHIP:
1. At the time of enrollment each covered person shall have the right toselect a primary care physician from among the health carrier's affiliatedprimary care physicians for the MCHIP, subject to availability.
2. Any covered person who is dissatisfied with his primary care physicianshall have the right to select another primary care physician from among theaffiliated primary care physicians, subject to availability. The healthcarrier may impose a reasonable waiting period for this transfer.
(1998, c. 891; 2000, c. 922; 2004, c. 715; 2006, c. 866.)