reglab/statecodes huggingface dataset:
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 10 - Utilization Review and Benefit Determinations › 3 AAC 28.912 - Procedures for expedited utilization review and benefit determinations

Current through May 31, 2024
(a) A health care
				  insurer shall establish and maintain written procedures for
(1) receiving a benefit request from a
				  covered person or the covered person's authorized representative;
(2) making an expedited utilization review
				  and benefit determination with respect to
(A)
				  an urgent care request; and
(B) a
				  concurrent review urgent care request; and
(3) notifying a covered person or the covered
				  person's authorized representative of the health care insurer's determination
				  not later than the specified time frames under this section.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 10 - Utilization Review and Benefit Determinations › 3 AAC 28.914 - Emergency services

Current through May 31, 2024
(a) A health care
				  insurer shall follow the provisions of this section when conducting a
				  utilization review or making a benefit determination for emergency
				  services.
(b) A health care insurer
				  shall cover emergency services to screen and stabilize a covered person
(1) without the need for prior authorization
				  of emergency services if a prudent person would reasonably believe that an
				  emergency medical condition exists even if the emergency services are provided
				  on an out-of-net work basis;
(2)
				  without regard to whether the health care provider furnishing the services is a
				  participating provider with respect to the services;
(3) if the emergency services are provided
				  out-of-network, without imposing an administrative requirement or limitation on
				  coverage that is more restrictive than the requirements or limitations that
				  apply to emergency services received from network providers;
(4) if the emergency services are provided
				  out-of-network, by complying with the cost-sharing requirements of (d) - (h) of
				  this section; and
(5) without
				  regard to another term or condition of coverage, other than
(A) the exclusion of, or coordination of,
				  benefits;
(B) an affiliation or
				  waiting period permitted under
				  42 U.S.C.
				  300gg -19a; or
(C) applicable cost-sharing, under (c) - (h)
				  of this section.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 10 - Utilization Review and Benefit Determinations › 3 AAC 28.916 - Confidentiality requirements

Current through May 31, 2024
A health care insurer shall annually certify in writing to
					 the director that the utilization review program of the health care insurer or
					 the health care insurer's designee complies with all applicable state and
					 federal laws that establish confidentiality and reporting requirements.
Authority:
AS
						21.06.090
AS
						21.07.005
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 10 - Utilization Review and Benefit Determinations › 3 AAC 28.918 - Disclosure requirements

Current through May 31, 2024
(a) A health care
				  insurer shall set out in, or attach to, a policy, certificate of coverage,
				  membership booklet, or other evidence of coverage provided to a covered person
				  by a health care insurer a clear and comprehensive description of the health
				  care insurer's utilization review procedures. The description must include
(1) the procedures for obtaining review of an
				  adverse determination; and
(2) a
				  statement of rights and responsibilities of a covered person with respect to
				  those procedures.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 11 - Health Care Insurer Grievance Procedures › 3 AAC 28.930 - Applicability

Current through May 31, 2024
Except as otherwise provided, 3 AAC 28.930- 3 AAC 28.938
					 apply to a health care insurer transacting health care insurance in this
					 state.
Authority:
AS
						21.06.090
AS
						21.07.005
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 11 - Health Care Insurer Grievance Procedures › 3 AAC 28.932 - Grievance reporting; recordkeeping requirements

Current through May 31, 2024
(a) A health care
				  insurer shall maintain a written calendar year register, in a manner that is
				  reasonably clear and accessible to the director, to document
(1) each grievance received;
(2) a general description of the reason for
				  the grievance;
(3) the date the
				  grievance was received;
(4) the
				  date of each review;
(5) resolution
				  of the grievance;
(6) the date of
				  resolution;
(7) the name of the
				  covered person for whom the grievance was filed;
(8) the health care insurer's review of each
				  grievance;
(9) notices and claims
				  associated with each grievance;
(10) each request for a review of a grievance
				  involving an adverse determination; and
(11) evidence sufficient to document
				  compliance with this section.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 11 - Health Care Insurer Grievance Procedures › 3 AAC 28.934 - Grievance review procedures

Current through May 31, 2024
(a) Except as
				  specified under 3 AAC 28.938, a health care insurer shall use written
				  procedures for receiving and resolving a grievance under 3 AAC 28.930 - 3 AAC 28.938.
(b) A covered person will
				  be considered to have exhausted the provisions of 3 AAC 28.930 - 3 AAC 28.938
				  if a health care insurer fails to adhere to the requirements of 3 AAC 28.936 or
				  3 AAC 28.938 and may
(1) file a request for
				  external review under 3 AAC 28.950 - 3 AAC 28.982; and
(2) pursue an available remedy under state or
				  federal law on the basis that the. health care insurer failed to provide a
				  reasonable internal claims and appeals process that would yield a decision on
				  the merits of the claim,
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 11 - Health Care Insurer Grievance Procedures › 3 AAC 28.936 - Reviews of grievances involving an adverse determination

Current through May 31, 2024
(a) A covered
				  person or the covered person's authorized representative may file a grievance
				  with a health care insurer requesting a review of an adverse determination, The
				  covered person or the covered person's authorized representative shall file the
				  request not later than 180 days after the covered person or the covered
				  person's authorized representative received notice of the adverse determination
				  under 3 AAC 28.900-3 AAC 28.918. The health care insurer shall extend the
				  180-day time period for filing a request if the
(1) covered person or the covered person's
				  authorized representative files a request with the health care insurer seeking
				  an extension; and
(2) the written
				  request for the extension sets out one or more justifications for the extension
				  that a prudent person would consider to be a fair and reasonable basis for
				  allowing the extension; the covered person or the covered person's authorized
				  representative does not need to file the request for an extension under this
				  subsection within the 180-day filing period.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 11 - Health Care Insurer Grievance Procedures › 3 AAC 28.938 - Expedited reviews of grievances involving an adverse determination

Current through May 31, 2024
(a) A health care
				  insurer shall establish written procedures for the expedited review of an
				  urgent care request of a grievance involving an adverse determination. The
				  procedures must allow a covered person or the covered person's authorized
				  representative to request an expedited review under this section orally or in
				  writing.
(b) In addition to (a) of
				  this section, a health care insurer shall provide expedited review of a
				  grievance involving an adverse determination with respect to a concurrent
				  review urgent care request involving
(1) an
				  admission;
(2) availability of
				  care;
(3) a continued stay;
				  or
(4) a health care service for a
				  covered person who has received emergency services but has not been discharged
				  from a facility.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 12 - External Review of Health Care Coverage Decisions › 3 AAC 28.950 - Applicability

Current through May 31, 2024
(a) Except under
				  (b) of this section, 3 AAC 28.950-3 AAC 28.982 apply to a health care insurer
				  that transacts health care insurance in this state.
(b) The provisions of 3 AAC 28.950 - 3 AAC 28.982 do not apply to
(1) a policy or
				  certificate that provides coverage only for a specified disease, specified
				  accident, or accident-only coverage, or for credit, disability income, hospital
				  indemnity, long-term care insurance defined under
				  AS
				  21.53.200, vision care, or other limited
				  supplemental benefit;
(2) a
				  Medicare supplement policy of insurance defined under
				  3 AAC 28.510;
(3) coverage under a plan through Medicare,
				  Medicaid, or the federal employees health benefits program;
(4) coverage issued under
				  10 U.S.C.
				  1071-
				  1110b,
				  and coverage issued as supplemental to that coverage;
(5) coverage issued as supplemental to
				  liability insurance;
(6) workers'
				  compensation or similar insurance;
(7) automobile medical-payment insurance or
				  insurance under which a benefit is payable without regard to fault, whether
				  written on a group blanket or individual basis.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 12 - External Review of Health Care Coverage Decisions › 3 AAC 28.952 - Notice of right to external review

Current through May 31, 2024
(a) A health care
				  insurer shall notify a covered person or the covered person's authorized
				  representative in writing of the covered person's right to request an external
				  review under 3 AAC 28.958 - 3 AAC 28.962. A health care insurer shall provide
				  the notice of the right to request an external review when the health care
				  insurer sends written notice of
(1) an
				  adverse determination upon completion of the health care insurer's utilization
				  review process under 3 AAC 28.900 - 3 AAC 28.918; and
(2) a final adverse determination.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 12 - External Review of Health Care Coverage Decisions › 3 AAC 28.954 - Request for external review

Current through May 31, 2024
(a) A covered
				  person or the covered person's authorized representative may make a request to
				  the director for an external review of an adverse determination or a final
				  adverse determination. Except for a request for an expedited external review, a
				  covered person or the covered person's authorized representative shall submit a
				  request for an external review to the director not later than 180 days after
				  the covered person or the covered person's authorized representative receives
				  notice of the adverse determination. The director will extend the 180-day time
				  period for filing the request if the
(1)
				  covered person or the covered person's authorized representative files a
				  written request with the director seeking an extension; and
(2) the request for the extension sets out
				  one or more justifications for the extension that a prudent person would
				  consider to be a fair and reasonable basis for allowing the extension; the
				  covered person or the covered person's authorized representative does not need
				  to file the request for an extension under this subsection within the 180-day
				  filing period.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 12 - External Review of Health Care Coverage Decisions › 3 AAC 28.956 - Exhaustion of internal grievance process

Current through May 31, 2024
(a) Except as
				  otherwise provided under this section, before making a request for an external
				  review, a covered person or the covered person's authorized representative must
				  exhaust a health care insurer's internal grievance process under 3 AAC 28.930 -
				  3 AAC 28.938.
(b) A covered person
				  or the covered person's authorized representative will be considered to have
				  exhausted a health care insurer's grievance process if the covered person or
				  the covered person's authorized representative
(1) has filed a grievance involving an
				  adverse determination; and
(2)
				  except to the extent the covered person or the covered person's authorized
				  representative requested or agreed to a delay, has not received a written
				  decision on the grievance from the health care insurer not later than 30 days
				  after the covered person or the covered person's authorized representative
				  filed the grievance with the health care insurer.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 12 - External Review of Health Care Coverage Decisions › 3 AAC 28.958 - Standard external review

Current through May 31, 2024
(a) A covered
				  person or a covered person's authorized representative may file a request with
				  the director for a standard external review of a health care insurer's adverse
				  determination or final adverse determination not later than 180 days after
(1) receipt of a notice of an adverse
				  determination or a final adverse determination;
(2) failure of a health care insurer to issue
				  a written decision not later than 30 days after the covered person or the
				  covered person's authorized representative filed a grievance involving an
				  adverse determination under 3 AAC 28.956(b); or
(3) agreement of the health care insurer to
				  waive the requirement that the covered person or the covered person's
				  authorized representative exhaust the health care insurer's internal grievance
				  procedures before filing a request for external review of an adverse
				  determination under 3 AAC 28.956(f).
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 12 - External Review of Health Care Coverage Decisions › 3 AAC 28.960 - Expedited external review

Current through May 31, 2024
(a) Except under
				  (k) of this section, a covered person or the covered person's authorized
				  representative may make an oral or written request to the director for an
				  expedited external review of a health care insurer's adverse determination or
				  final adverse determination when the covered person or the covered person's
				  authorized representative receives
(1) an
				  adverse determination that
(A) involves a
				  medical condition of the covered person for which the time frame for completion
				  of an expedited internal review of a grievance involving an adverse
				  determination would seriously jeopardize the life or health of the covered
				  person or would jeopardize the covered person's ability to regain maximum
				  function; and
(B) the covered
				  person or the covered person's authorized representative has filed a request
				  for an expedited review of a grievance involving an adverse determination;
				  or
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 12 - External Review of Health Care Coverage Decisions › 3 AAC 28.962 - External review of experimental or investigational treatment adverse determinations

Current through May 31, 2024
(a) A covered
				  person or the covered person's authorized representative may file a request
				  with the director for an external review not later than 180 days after receipt
				  of a health care insurer's notice of adverse determination or final adverse
				  determination that involves a denial of coverage based on a determination that
				  the health care service or treatment recommended or requested is experimental
				  or investigational. The director will extend the 180-day time period for filing
				  the request if the
(1) covered person or the
				  covered person's authorized representative files a written request with the
				  director seeking an extension; and
(2) the written request for the extension
				  sets out one or more justifications for the extension that a prudent person
				  would consider to be a fair and reasonable basis for allowing the extension;
				  the covered person or the covered person's authorized representative does not
				  need to file the request for an extension under this subsection within the
				  180-day filing period.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 12 - External Review of Health Care Coverage Decisions › 3 AAC 28.964 - Declination of external review assignment by the independent review organization

Current through May 31, 2024
Not later than 24 hours after receipt of an assignment to
					 conduct an external review under 3 AAC 28.958(i)(1), 3 AAC 28.960(e)(1), or 3 AAC 28.962(f)(1), an independent review organization shall
(1) make a determination of the independent
				  review organization's ability to perform the external review; and
(2) advise the director if the independent
				  review organization is unable to perform the review due to
(A) conflict of interest; or
(B) lack of expertise or qualification for
				  the particular subject matter of the review.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 12 - External Review of Health Care Coverage Decisions › 3 AAC 28.966 - Binding nature of external review decision

Current through May 31, 2024
(a) An external
				  review decision is binding on a health care insurer except to the extent the
				  health care insurer has other remedies available under applicable state
				  law.
(b) An external review
				  decision is binding on the covered person except to the extent the covered
				  person has other remedies under applicable federal or state law.
(c) A covered person or the covered person's
				  authorized representative may not file a subsequent request for external review
				  involving the same adverse determination or final adverse determination for
				  which the covered person has already received an external review
				  decision.
Authority:
AS
						21.06.090
AS
						21.07.005
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 12 - External Review of Health Care Coverage Decisions › 3 AAC 28.968 - Term of initial independent review organization registration period; renewal

Current through May 31, 2024
(a) An initial
				  biennial independent review Organization registration period includes the rest
				  of the calendar year in which the registration is issued and all of the
				  following calendar year.
(b) If the
				  director issues an initial biennial independent review organization
				  registration on or after October 1, the registration period includes the rest
				  of the calendar year in which the registration is issued and all of the
				  following two calendar years.
(c)
				  An independent review organization is responsible for knowing the date that the
				  independent review organization's biennial registration period ends and for
				  submitting a renewal independent review organization registration application
				  not later than 30 days before the next biennial registration period
				  begins.
Authority:
AS
						21.06.090
AS
						21.07.005
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 12 - External Review of Health Care Coverage Decisions › 3 AAC 28.970 - Approval of independent review organizations; registration

Current through May 31, 2024
(a) The director
				  may assign an independent review organization to conduct an external review in
				  this state if the independent review organization
(1) has an approved registration application
				  on file with the director;
(2) has
				  paid the independent review organization biennial registration fee under
				  3 AAC 31.060;
(3) is currently in good standing in this
				  state;
(4) is accredited by a
				  nationally recognized private accrediting agency that the director determines
				  has independent review organization accreditation standards that are equivalent
				  to, or exceed, the minimum qualifications for independent review organizations
				  under 3 AAC 28.974; and
(5) meets
				  the minimum qualifications under 3 AAC 28.974.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 12 - External Review of Health Care Coverage Decisions › 3 AAC 28.972 - Examination; suspension or revocation of registration

Current through May 31, 2024
(a) To determine
				  compliance with 3 AAC 28.950 - 3 AAC 28.989, the director may examine the
				  affairs, transactions, accounts, records, and documents of an independent
				  review organization. The director, after a hearing, may suspend or revoke an
				  independent review organization registration for failure to meet the
				  requirements under 3 AAC 28.970(a).
(b) The director wit) suspend an independent
				  review organization's registration for a fixed period of time determined by the
				  director, or until the occurrence of a specific event necessary for remedying
				  the reasons for suspension. The director may modify, rescind, or reverse a
				  suspension under this section.
(c)
				  During a period of suspension, the director will not assign the independent
				  review organization to conduct an external review in this state. The
				  independent review organization may continue to conduct an external review
				  assigned before the suspension if the director determines completion of the
				  assignment to be in the best interests of the public.
Authority:
AS
						21.06.090
AS
						21.07.005
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 12 - External Review of Health Care Coverage Decisions › 3 AAC 28.974 - Minimum qualifications for independent review organizations

Current through May 31, 2024
(a) An independent
				  review organization is eligible to conduct external reviews under 3 AAC 28.950
				  - 3 AAC 28.982, if the independent review organization has and maintains
				  written policies and procedures that govern all aspects of the standard
				  external review process and the expedited external review process and include,
				  at a minimum, the following:
(1) a quality
				  assurance mechanism that ensures
(A) that
				  external reviews are conducted not later than the specified time frames and
				  that required notices are provided in a timely manner;
(B) the selection of qualified and impartial
				  clinical reviewers to conduct external reviews on behalf of the independent
				  review organization, and the suitable matching of reviewers to specific
				  cases;
(C) that the independent
				  review organization employs or contracts with an adequate number of clinical
				  reviewers to meet the objectives under (B) of this paragraph;
(D) the confidentiality of medical and
				  treatment records and clinical review criteria;
(E) the establishment and maintenance of
				  written procedures to ensure that the independent review organization is
				  unbiased, in addition to other procedures required under this section;
				  and
(F) that a person employed by
				  or under contract with the independent review organization adheres to the
				  requirements under 3 AAC 28.950 - 3 A.AC 28.982;
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 12 - External Review of Health Care Coverage Decisions › 3 AAC 28.976 - Immunity for independent review organizations

Current through May 31, 2024
An independent review organization, a clinical reviewer
					 working on behalf of an independent review organization, or an employee, agent,
					 or contractor of an independent review organization may not be liable in
					 damages to a person for an opinion rendered, or act or omission performed,
					 within the scope of the duties of the organization, the clinical reviewer, or
					 an employee, agent, or contractor of the organization under 3 AAC 28.950 - 3 AAC 28.982 during, or upon completion of, an external review conducted under 3 AAC 28.950 - 3AAC 28.982, unless the opinion was rendered, or the act or
					 omission was performed, in bad faith or involved gross negligence.
Authority:
AS
						21.06.090
AS
						21.07.005
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 12 - External Review of Health Care Coverage Decisions › 3 AAC 28.980 - Funding of external review

Current through May 31, 2024
A health care insurer against which a request for a
					 standard external] review or an expedited external review is filed shall pay
					 the cost of the independent review organization to conduct the external review.
Authority:
AS
						21.06.090
AS
						21.07.005
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 12 - External Review of Health Care Coverage Decisions › 3 AAC 28.982 - Disclosure requirements

Current through May 31, 2024
A health care insurer shall set out in, or attach to, a
					 policy, certificate of coverage, membership booklet, or other evidence of
					 coverage provided to a covered person a description of the external review
					 procedures described under 3 AAC 28.950"3 AAC 28.982. The description must
					 include
(1) a statement of the covered
				  person's or the covered person's authorized representative's right to file a
				  request for an external review of an adverse determination or final adverse
				  determination with the director; the statement must include the division's
				  current mailing address, electronic mail address, telephone number, and
				  facsimile transmission number;
(2)
				  a statement informing the covered person that, when filing a request for an
				  external review, the covered person will be required to authorize the release
				  of medical records of the covered person that may be required to be reviewed
				  for the purpose of reaching a decision on the external review;
(3) a brief description, including timelines,
				  of each type of external review process; and
(4) a statement of the covered person or the
				  covered person's authorized representative's right to provide additional
				  information or otherwise participate in the external review process.
Authority:
AS
						21.06.090
AS
						21.07.005
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 13 - General Provisions: Utilization Review and Benefit Determinations, Health Care Insurer Grievance Procedures, and External Review of Health Care Coverage Decisions › 3 AAC 28.989 - Definitions

Current through May 31, 2024
In 3 AAC 28.900 - 3 AAC 28.989, unless the context requires
					 otherwise,
(1) "adverse determination"
				  includes a rescission of coverage determination and means
(A) a determination by a health care insurer
				  or the health care insurer's designee utilization review organization that
(i) based upon the information provided, a
				  request for a benefit under the health care insurer's health care insurance
				  policy upon application of a utilization review technique does not meet the
				  health care insurer's requirements for medical necessity, appropriateness,
				  health care setting, level of care, or effectiveness or is determined to be
				  experimental or investigational, and the requested benefit is therefore denied,
				  reduced, or terminated or payment is riot provided or made, in whole or in
				  part, for the benefit; or
(ii) an
				  admission, availability of care, continued stay, or other health care service
				  or treatment that is a covered benefit has been reviewed and, based upon the
				  information provided, does not meet the health care insurer's requirements for
				  medical necessity, appropriateness, health care setting, level of care, or
				  effectiveness, and the requested service or payment for the service is
				  therefore denied, reduced, or terminated;
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 2 - Rate and Rating Plan Filings › 3 AAC 29.200 - Scope

Current through May 31, 2024
(a)3 AAC 29.200 -
				  3 AAC 29.300 apply to all insurance subject to rate
				  regulation under AS 21.39.
(b)3 AAC 29.200 -
				  3 AAC 29.300 do not apply to any insurance for which the
				  filing requirement has been suspended or modified by a written order of the
				  director.
Authority:
AS
						21.06.090
AS
						21.39.130
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 2 - Rate and Rating Plan Filings › 3 AAC 29.210 - Rating organization filing

Current through May 31, 2024
(a) A rating
				  organization may develop and submit to the director a filing consisting of
				  prospective loss costs supported by statistical data, interpretation of the
				  statistical data, relevant experience or judgment, and other supporting
				  information.
(b) A rating
				  organization may develop and submit a filing of supplementary rating
				  information.
(c) Repealed
				  1/17/98.
(d) A rating organization
				  may print and distribute prospective loss cost data, rules, and other
				  supplementary rating information.
Authority:
AS
						21.06.090
AS 21.39.040
AS
						21.39.130
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 2 - Rate and Rating Plan Filings › 3 AAC 29.220 - Insurer filing responsibilities

Current through May 31, 2024
(a) An insurer may
(1) develop and submit its own filing of
				  rates supported by statistical data, interpretation of the statistical data,
				  relevant loss and expense experience or judgment, and other supporting
				  information as required by the director; or
(2) submit a loss cost adjustment filing that
				  adopts the prospective loss costs filing made by the rating organization of
				  which the insurer is a participating insurer, and applies the insurer's own
				  loss cost adjustments; except as provided in
				  3 AAC 29.240(c), an insurer must adopt the
				  rating organization filing of prospective loss costs that will be in effect on
				  the effective date of the insurer's loss cost adjustment filing.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 2 - Rate and Rating Plan Filings › 3 AAC 29.240 - Insurer loss cost adjustment filing

Current through May 31, 2024
(a) Loss cost
				  adjustments included in an insurer's lost cost adjustment filing may be based
				  on the insurer's operating methods for each kind of insurance and the
				  measurable variations of expenses within that kind of insurance. The loss cost
				  adjustments in the filing must be supported by the insurer's statistical data,
				  interpretation of the data, expense experience and judgment, and other relevant
				  information.
(b) Repealed
				  12/24/93.
(c) When making a loss
				  cost adjustment filing, an insurer may elect to apply the loss cost adjustments
				  to subsequently approved filings of prospective loss costs of its rating
				  organization. If the insurer so elects, upon division approval of a subsequent
				  rating organization filing of prospective loss costs, the insurer's rates will
				  be the combination of the newly approved prospective loss costs and the
				  approved loss cost adjustments on file with the division, and will become
				  effective on the date specified in the filing of the prospective loss costs
				  unless a different effective date is approved by the director. However, if an
				  insurer determines that there is a significant change in the expenses it
				  anticipates for a kind of insurance that would cause the insurer's rates to be
				  excessive, inadequate, or unfairly discriminatory, the insurer shall file a
				  revision of the loss cost adjustments with the director.
(d) If the rates of a participating insurer
				  of a rating organization for a kind of insurance are determined solely by
				  applying the insurer's loss cost adjustments already filed to the prospective
				  loss costs contained in the rating organization filing, the insurer is not
				  required to make an additional filing to combine the prospective loss costs
				  with the loss cost adjustments.
(e)
				  Repealed 3/11/98.
(f) An insurer
				  may file more than one loss cost adjustment to apply to the prospective loss
				  costs from a single rating organization filing only if the insurer
(1) clearly specifies which loss cost
				  adjustment is applicable to which policyholders; and
(2) demonstrates to the director's
				  satisfaction that the different loss cost adjustments are necessary to
				  accommodate different expected expenses or losses.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 2 - Rate and Rating Plan Filings › 3 AAC 29.250 - Insurer rate filing

Current through May 31, 2024
(a) Repealed 12/24/93.
(b) Repealed 12/24/93.
(c) An insurer's rate filing must be
				  consistent with the estimate of future costs of a risk transfer as established
				  in the Casualty Actuarial Society's Statement of Principles Regarding Property
				  and Casualty Ratemaking, adopted May 1988. The costs must include estimated
				  future losses, loss adjustment expenses, and other expenses.
(d) Repealed 3/11/98.
(e) If an insurer relies upon the loss costs
				  of a rating organization to support its rates, the insurer must use the
				  approved prospective loss costs of the rating organization in effect at the
				  time of the use.
The Casualty Actuarial Society's Statement of Principles
						Regarding Property and Casualty Ratemaking, adopted May 1988, referenced in
						3 AAC 29.250(c) may be obtained from
						the Casualty Actuarial Society; 1100 North Glebe Road, Suite 600; Arlington, VA
						22201-4798; telephone number (703)
						276-3100.
Authority:
AS
						21.06.090
AS 21.39.040
AS
						21.39.130
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 2 - Rate and Rating Plan Filings › 3 AAC 29.290 - Limits on using accidents or losses in automobile rating

Current through May 31, 2024
(a) An insurer may
				  not cancel, deny, nonrenew, underwrite, or rate an automobile insurance policy
				  based upon
(1) an accident or claim involving
				  an applicant or insured unless
(A) the
				  accident involved injury to a person or more than $1,000 damage to property;
				  and
(B) the applicant or insured
				  has been determined to be 50 percent or more at fault; the determination of
				  fault must be based on a reasonable investigation of all of the available
				  information and may not be based solely on the existence of the accident in a
				  database or motor vehicle record report that identifies accidents without
				  regard to fault; the insurer shall determine the applicant or insured not to be
				  at fault for an accident that occurs under the following circumstances:
(i) the automobile was lawfully parked; the
				  insurer is not required to determine an automobile rolling from a parked
				  position to be lawfully parked, but may determine the rolling to be the
				  operation of the last operator;
(ii) the applicant, insured, or owner of the
				  motor vehicle is, reimbursed by or on behalf of a person responsible for the
				  accident, a judgment against the responsible person exists, or the insurer is
				  able to subrogate its payment to the insured, if the reimbursement, judgment,
				  or subrogation is 50 percent or more of the damages associated with the
				  accident;
(iii) the applicant or
				  insured was struck in the rear and has not been convicted of a moving traffic
				  violation in connection with the accident;
(iv) another party was convicted of a moving
				  traffic violation in connection with the accident and the applicant or insured
				  was not;
(v) the owner and operator
				  of the other vehicle is unknown or has left the scene and the applicant or
				  insured reported the accident to the appropriate authorities within 24
				  hours;
(vi) damage is the result of
				  contact with animals;
(vii) damage
				  is caused only by flying gravel, missiles, or falling objects; or
(viii) the accident occurs while the insured
				  is using the motor vehicle in response to an emergency if the insured is a paid
				  or voluntary member of a police or fire department, first-aid squad, or law
				  enforcement agency at the time of the accident;
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 2 - Rate and Rating Plan Filings › 3 AAC 29.300 - Definitions

Current through May 31, 2024
In
					 3 AAC 29.200 -
					 3 AAC 29.300, unless the context otherwise
					 requires,
(1) "director" means the
				  director of the division of insurance;
(2) "division" means the division of
				  insurance;
(3) "expenses" means
				  that portion of a rate attributable to acquisition, field supervision, and
				  collection expenses, general expenses, taxes, licenses, and fees;
(4) "loss adjustment expense" means the cost
				  of adjusting losses, excluding the amount of the loss itself;
(5) "loss cost adjustments" means that
				  portion of a rate that includes
(A)
				  provisions for expenses, other than loss adjustment expenses;
(B) all forms of profit, including investment
				  income; and
(C) any modification to
				  the prospective loss costs filed by the rating organization;
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 3 - Group-Marketed Property and Casualty Insurance › 3 AAC 29.305 - Purpose

Current through May 31, 2024
The purpose of
					 3 AAC 29.305 -
					 3 AAC 29.369 is to prevent abuses in the group-marketing
					 of property and casualty insurance in this state, while preserving for
					 consumers the potential benefits of this form of marketing.
Authority:
AS
						21.06.090
AS
						21.36.020
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 3 - Group-Marketed Property and Casualty Insurance › 3 AAC 29.310 - Applicability

Current through May 31, 2024
3 AAC 29.305 -
					 3 AAC 29.369 apply to all property and casualty
					 insurance policies or renewals delivered or issued for delivery in this state
					 after 12/31/94 that are sold through a group-marketed plan.
Authority:
AS
						21.06.090
AS
						21.36.020
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 3 - Group-Marketed Property and Casualty Insurance › 3 AAC 29.315 - Fictitious arrangement prohibited

Current through May 31, 2024
An insurer may group-market insurance only to employees of
					 a particular employer or to members of an association, organization or other
					 group formed for a specific purpose that is unrelated to the purpose of
					 obtaining insurance through a group-marketed plan.
Authority:
AS
						21.06.090
AS 21.36.020
AS
						21.36.190
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 3 - Group-Marketed Property and Casualty Insurance › 3 AAC 29.320 - Premium rates

Current through May 31, 2024
Premium rates under a group-marketed plan must comply with
					 AS 21.39. Rates are not unfairly discriminatory merely because different
					 premiums result for policyholders with like loss exposures but different
					 expense factors, or like expense factors but different loss exposures, as long
					 as the rates reflect the differences with reasonable accuracy. Rates are not
					 unfairly discriminatory if they are averaged broadly among persons insured
					 under a group-marketed plan.
Authority:
AS
						21.06.090
AS 21.36.190
AS 21.39.020
AS 21.39.030
AS 21.39.040
AS
						21.39.130
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 3 - Group-Marketed Property and Casualty Insurance › 3 AAC 29.325 - Statistics

Current through May 31, 2024
An insurer selling insurance through a group-marketed plan
					 shall maintain separate statistics for the loss and expense experience of the
					 group-marketed plan.
Authority:
AS
						21.06.090
AS
						21.39.130
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 3 - Group-Marketed Property and Casualty Insurance › 3 AAC 29.330 - Producers

Current through May 31, 2024
A person may not act as or represent to be an insurance
					 producer for a group-marketed plan in this state unless licensed under AS
					 21.27.
Authority:
AS
						21.06.090
AS
						21.27.010
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 3 - Group-Marketed Property and Casualty Insurance › 3 AAC 29.335 - Compulsory participation prohibited

Current through May 31, 2024
An insurer may not sell insurance through a group-marketed
					 plan if
(1) the purchase of insurance
				  through the group-marketed plan is a condition of employment or of membership
				  in an association, organization, or other group; or
(2) an employee or a member may be penalized
				  for nonparticipation in the group-marketed plan.
Authority:
AS
						21.06.090
AS
						21.36.080
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 3 - Group-Marketed Property and Casualty Insurance › 3 AAC 29.340 - Tie-in sales prohibited

Current through May 31, 2024
An insurer may not sell insurance through a group-marketed
					 plan in this state if (1) the purchase of insurance available under the plan is
					 contingent upon the purchase of any other insurance, product, or service; or
					 (2) the purchase or price of any other insurance, product, or service is
					 contingent upon the purchase of insurance available under the group-marketed
					 plan. A reasonable requirement of safety devices, such as heat detectors,
					 lightning rods, or theft prevention equipment, is permitted in the sale of
					 insurance through a group-marketed plan.
Authority:
AS
						21.06.090
AS
						21.36.080
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 3 - Group-Marketed Property and Casualty Insurance › 3 AAC 29.345 - Disclosure required

Current through May 31, 2024
Before each sale, an insurer or producer selling insurance
					 through a group-marketed plan shall disclose to a prospective insured all
					 features of the plan, whether favorable or unfavorable, including premium
					 rates, benefits, duration of coverage, policyholder services, conversion
					 privileges available, and the financial interest in the plan of the sponsoring
					 employer, association, organization, or group.
Authority:
AS
						21.06.090
AS
						21.36.030
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 29 - Property, Casualty, and Related Insurance › Article 3 - Group-Marketed Property and Casualty Insurance › 3 AAC 29.350 - Underwriting standards

Current through May 31, 2024
(a) An insurer may not use underwriting
				  standards for individual risk selection in a group-marketed plan that are more
				  restrictive overall than the standards used by the insurer for individual risk
				  selection in the sale of the same kind of insurance in this state when a
				  group-marketed plan is not used.
(b) If an insurer does not sell a kind of
				  property or casualty insurance in this state other than through a
				  group-marketed plan, the underwriting standards for individual risk selection
				  in the group-marketed plan may not be more restrictive overall than the
				  standards used by the insurer's principal affiliate for individual risk
				  selection in the sale of the same kind of property or casualty insurance in
				  this state when a group-marketed plan is not used.
Authority:
AS
						21.06.090
AS
						21.36.090