Uniform Health Carrier External Review Model Act

This document is about a model act developed by the National Association of Insurance Commissioners (NAIC) that provides uniform standards for the establishment and maintenance of external review procedures to assure that covered persons have the opportunity for an independent review of an adverse determination or final adverse determination by their health carrier. The act covers definitions, applicability, notice requirements, the external review process, approval and qualifications of independent review organizations, reporting requirements, disclosure, and other provisions to ensure consumers have access to an independent external review of certain health insurance coverage decisions.