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 Rates and 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 Rates and 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