A panel at the National Association of Insurance Commissioners has given its blessing to a model act that would establish uniform standards for external health insurance review procedures.
The regulatory framework task force at the NAIC, Kansas City, Mo., has approved a draft of the Uniform Health Carriers External Review model act and sent it up to the NAIC’s Health Insurance and Managed Care Committee.
The committee is expected to consider the draft at the NAIC’s spring meeting, which is set to start March 28 in Orlando, Fla.
The model would apply to systems for reviewing adverse determinations and final adverse determinations affecting individuals covered by health insurance.
The model would exempt specified disease, specified accident and accident-only policies.
The model also would exempt public insurance programs and credit, dental, disability income, hospital indemnity, long term care, vision care, limited benefit and Medicare supplement insurance plans.