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Texas Insurance Code - INS § 1355.2571. Parity Complaint Portal

Current as of January 01, 2024 | Updated by Findlaw Staff

(a) The commissioner shall develop and maintain a parity complaint portal that is an integrated system that allows for the enrollee of a health benefit plan to submit complaints of suspected violations of the provisions of this subchapter.  The parity complaint portal must:

(1) allow for an enrollee to submit a complaint through multiple ways;

(2) provide updates on the status of an enrollee's complaint;

(3) ensure timely, effective, and equitable resolution for submitted complaints;

(4) include educational materials regarding:

(A) benefits for mental health conditions and substance use disorders required under this subchapter;

(B) an enrollee's rights and responsibilities under a health benefit plan concerning coverage under this subchapter;

(C) circumstances under which a claim may be denied;  and

(D) the processes for reviewing a complaint submitted through the portal;

(5) adhere to national best practices as determined by the commissioner;  and

(6) include the findings of the report required by Section 1355.2572(b).

(b) In developing the parity complaint portal under Subsection (a), the commissioner:

(1) shall conduct an assessment of complaint portals and similar systems used by other relevant public or private entities;

(2) shall develop best practice standards for complaint submissions and tracking consistent with the findings of the assessment conducted under Subdivision (1);  and

(3) may develop a new complaint portal or modify an existing complaint portal.

(c) The Health and Human Services Commission shall appoint a liaison to the department to receive reports of concerns, complaints, and potential violations submitted through the parity complaint portal established under Subsection (a).

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Cite this article: FindLaw.com - Texas Insurance Code - INS § 1355.2571. Parity Complaint Portal - last updated January 01, 2024 | https://codes.findlaw.com/tx/insurance-code/ins-sect-1355-2571/

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