4-5 Vt. Code R. 3:10.200 - Basic consumer protections required of all managed care organizations under the Department Financial Regulation regulations

“Basic consumer protections required of all managed care organizations under the Department Financial Regulation regulations”

(2.1) Each managed care organization must establish policies, standards, and procedures to protect the confidentiality, security and integrity of individually-identifiable health care information in its possession. 

(2.2) Each managed care organization is responsible for plan documents, which must be made available in hard or electronic copy to prospective members prior to enrollment and to each subscriber. The plan documents or handbook must contain among other things:

• The health benefit’s coverage provisions.
• A description of the grievance process used to resolve disputes between a member and the managed care organization and how a member can access that process. 
• A summary of the managed care organization’s quality management program.
• The member’s responsibility for payment of premiums, coinsurance, copayments, deductibles and other charges, annual limits, caps on payments for covered services, and the member’s financial responsibility for non-covered procedures, treatments, or services.

(2.5) A managed care organization that does not use utilization management mechanisms must have a review process available to address and resolve member grievances that meets the state’s regulatory requirements.