Prior to issuing a decision in accordance with the timeframes provided in § 58-17I-9, the health carrier shall provide free of charge to covered person, or the covered person’s authorized representative, any new or additional evidence, relied upon or generated by the health carrier, or at the direction of the health carrier, in connection with the grievance sufficiently in advance of the date the decision is required to be provided to permit the covered person, or the covered person’s authorized representative, a reasonable opportunity to respond prior to that date.

Before the health carrier issues or provides notice of a final adverse determination in accordance with the timeframes provided in § 58-17I-9 that is based on new or additional rationale, the health carrier shall provide the new or additional rationale to the covered person, or the covered person’s authorized representative, free of charge as soon as possible and sufficiently in advance of the date the notice of final adverse determination is to be provided to permit the covered person, or the covered person’s authorized representative a reasonable opportunity to respond prior to that date.

Source: SL 2011, ch 219, § 82.

Commission Note: SL 2012, ch 239, § 1 provides: “The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.”