Life & Health
The Life & Health Section is composed of the Rates and Forms Review Unit, the Medical Director/Private Review Agent Oversight Unit, the Life & Health Complaint Unit, and the Appeals & Grievance Unit.
The Rate & Forms Review Unit oversees the contracts written by insurers, health maintenance organizations (HMOs), nonprofit health service plans, and dental plan organizations. The types of contracts reviewed by the Rate & Forms Review Unit include life insurance, health insurance, annuities, credit insurance, dental insurance, disability insurance and long-term care insurance.
The Life & Health Complaint Unit is primarily responsible for investigating life and health insurance complaints filed by consumers and providers. The Appeals & Grievance Unit investigates health insurance complaints that are based on medical necessity.
The Medical Director/Private Review Agent Oversight Unit is responsible for reviewing applications for Private Review Agent certification. This unit also reviews the qualifications of applicants seeking certification as a Medical Director of a Health Maintenance Organization.
For more information about the activities of this section, refer to:
- Rates and Forms
- File A Complaint
- Appeals and Grievance
- Company Reporting Form for Adverse Decisions and Grievances