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- Alaska Statutes.
- Title 21. Insurance
- Chapter 7. Patient Protections Under Health Care Insurance Policies
- Section 5. Regulations Relating to Health Care Insurance Policies.
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Chapter 7. Regulation of Managed Care Insurance Plans
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Section 10. Patient and Health Care Provider Protection.
AS 21.07.005. Regulations Relating to Health Care Insurance Policies.
(a) The director shall adopt regulations to provide standards and criteria for
(1) the structure and operation of utilization review and benefit determination processes;
(2) the establishment and maintenance of procedures by health care insurers to ensure that a covered individual has the
opportunity for appropriate resolution of grievances; and
(3) an independent review of an adverse determination or final adverse determination.
(b) The regulations under (a) of this section must be at least as restrictive as the Utilization Review and Benefit Determination
Model Act adopted by the National Association of Insurance Commissioners on June 22, 2003, the Health Carrier Grievance Procedure Model
Act adopted by the National Association of Insurance Commissioners on June 22, 2003, and the Uniform Health Carrier External Review
Model Act adopted by the National Association of Insurance Commissioners on June 2, 2008.
(c) The director may adopt regulations for the registration and regulation of independent review organizations, including the establishment
of fees in an amount the director determines to be sufficient to reimburse the state for actual expenses incurred in providing a service.
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