514I.6  Participating insurers.

Participating insurers shall meet the qualifying standards established by rule under this chapter and shall perform all of the following functions:

1.  Provide plan cards and membership booklets to qualifying families.

2.  Provide or reimburse accessible, quality medical services.

3.  Submit a marketing plan to the HAWK-I board which is consistent with the board's outreach plan, for approval by the board.

4.  Require that any plan provided by the participating insurer establishes and maintains a conflict management system that includes methods for both preventing and resolving disputes involving the health care needs of eligible children, and a process for resolution of such disputes.

5.  Provide the administrative contractor with all of the following information pertaining to the participating insurer's plan:

a.  A list of providers of medical services under the plan.

b.  Information regarding plan rules relating to referrals to specialists.

c.  Information regarding the plan's conflict management system.

d.  Other information as directed by the board.

6.  Submit a plan for a health improvement program to the department, for approval by the board.

7.  Develop a plan for provider network development including criteria for access to pediatric subspecialty services.

Section History: Recent form

  98 Acts, ch 1196, §7, 16

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