                                 CODE OF VIRGINIA

DISCLOSURE REQUIREMENTS (§ 38.2-3570)

Each health carrier shall include a description of the external review
procedures in or attached to the policy, certificate, membership booklet,
outline of coverage, or other evidence of coverage it provides to covered
persons. The description shall include a statement that informs the covered
person of his right to file a request for an external review of an adverse
determination or final adverse determination with the Commission. The statement
shall explain that external review is available when the adverse determination
or final adverse determination involves an issue of medical necessity,
appropriateness, health care setting, level of care, or effectiveness. The
statement shall include the telephone number and address of the Commission. The
statement shall inform the covered person that, when filing a request for an
external review, the covered person will be required to authorize the release of
any medical records of the covered person that may be required to be reviewed
for the purpose of reaching a decision on the external review.

HISTORY: 2011, c. 788.