Res 1988-077 - Laserfiche WebLink

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SECTION V COMPLAINT PROCEDURES If a Covered Person has a complaint concerning the provision of Health Set'vices I)r benefits under this CI:lntract, a written complairlt may be directed to Health Plan at 3307 Northland Drivei Suite 300, Austin, Texas, ì3731 i (51ê:) 454-6771. The Health Plan President complainant and attempt discussions~ consultations of the resolution of the t'ece i pt. or other authorized person shall contact the to resolve the complaint through informal or conferences and shall notify the complainant complaint within thirty (30) days following its If fUt..thet' t'equested in wt'iting by the C,:)vered Pet'soy.. fl:)Il,)wing infQrmal attempts to resolve the complaint Health Plan shall direct the complaint to a committee appointed by the Board of Trustees which shall consist of tWQ (2) physician membersi two (2) consumet'members, and the President, and which shall be empowered to resolve or recommend the resolution of the compla.irlt. The committee shall advise the cI:)mplainant I:)f the date and place I:)f a hearing, which shall be held within sixty (60) days following the receipt of the request, at which time testimony, explanation Qr other information will be received from Covered Persons, staff persons, administrators, providers, or other pet'sons as is deemed necessary for a fair appraisal of the complaint. The Committee shall advise the complainant in writing of their findings within thirty (30) days of the conclusion of the hearing and of the complainant's right to further legal action. SECTION VI TERMINATION OF INDIVIDUAL COVERAGE Coverage of the Covet'ed Person under this Contract shall automatically ter'minate or, the ear'liest ,:of the f')llowing dates: 1. The date this Contract is terminated, (or with respect to any specific coverage item of this Contract, the date such coverage item is no longet' cl:,vet'ed.) ~, c:.. The end of the last Contract Month that the required Enrollee contribution toward the Health Services Fee has been paid, if the Em'I:,llee is t'eqltÍt'ed to make such a cl:)ntribut icln. .. w. In the case of an Enrollee who fails to pay a required CQpayment Chaq;le fot' Health Set'vices t'eridered, the date speci fied by Health Plarl for termination of coverage in written notice to the Enrolling Unit. Such notice shall be provided by Health Plan at least sixty (60) days in advance of such termination. 4. A dependent chil~ ceases to meet definition of "dependent child" in Section I of the Contract. GH-12-13