F:\P11\NHI\TRICOMM\AAHCA09_001.

XML

38
1 published on November 21, 2000 (65 Fed. Reg. 70246)
2 and shall update such process in accordance with any
3 standards that the Commissioner may establish.
4 (c) EXTERNAL REVIEW PROCESS.—
5 (1) IN GENERAL.—The Commissioner shall es-
6 tablish an external review process (including proce-
7 dures for expedited reviews of urgent claims) that
8 provides for an impartial, independent, and de novo
9 review of denied claims under this division.
10 (2) REQUIRING FAIR GRIEVANCE AND APPEALS

11 MECHANISMS.—A determination made, with respect

12 to a qualified health benefits plan offered by a
13 QHBP offering entity, under the external review
14 process established under this subsection shall be
15 binding on the plan and the entity.
16 (d) CONSTRUCTION.—Nothing in this section shall be
17 construed as affecting the availability of judicial review
18 under State law for adverse decisions under subsection (b)
19 or (c), subject to section 151.
20 SEC. 133. REQUIRING INFORMATION TRANSPARENCY AND

21 PLAN DISCLOSURE.

22 (a) ACCURATE AND TIMELY DISCLOSURE.—

23 (1) IN GENERAL.—A qualified health benefits
24 plan shall comply with standards established by the
25 Commissioner for the accurate and timely disclosure

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC