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published on November 21, 2000 (65 Fed. Reg. 70246) 1

and shall update such process in accordance with any 2
standards that the Commissioner may establish. 3
(c) EXTERNAL REVIEW PROCESS. 4
(1) IN GENERAL.The Commissioner shall es- 5
tablish an external review process (including proce- 6
dures for expedited reviews of urgent claims) that 7
provides for an impartial, independent, and de novo 8
review of denied claims under this division. 9
(2) REQUIRING FAIR GRIEVANCE AND APPEALS 10
MECHANISMS.A determination made, with respect 11
to a qualified health benefits plan offered by a 12
QHBP offering entity, under the external review 13
process established under this subsection shall be 14
binding on the plan and the entity. 15
(d) CONSTRUCTION.Nothing in this section shall be 16
construed as affecting the availability of judicial review 17
under State law for adverse decisions under subsection (b) 18
or (c), subject to section 151. 19
SEC. 133. REQUIRING INFORMATION TRANSPARENCY AND 20
PLAN DISCLOSURE. 21
(a) ACCURATE AND TIMELY DISCLOSURE. 22
(1) IN GENERAL.A qualified health benefits 23
plan shall comply with standards established by the 24
Commissioner for the accurate and timely disclosure 25
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