Vermont Statutes Title 8 Sec. 5102a
Terms Used In Vermont Statutes Title 8 Sec. 5102a
- Commissioner: means the Commissioner of Financial Regulation. See
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Grievance: means a written complaint submitted to the Department or to the health maintenance organization in accordance with the health maintenance organization's formal grievance procedure by or on behalf of a member regarding any aspect of the health maintenance organization relative to the member. See
- Health maintenance organization: means any person who furnishes, either directly or through arrangements with others, comprehensive health care services to an enrolled member in return for periodic payments; the amounts of said payments are agreed upon prior to the time during which the health care services may be furnished; and who is obligated to the member to arrange for or to provide directly available and accessible health care services. See
§ 5102a. Grievance procedures
A health maintenance organization shall establish and maintain a grievance or complaint handling procedure that has been approved by the Commissioner to provide for the resolution of grievances and complaints initiated by members. The organization shall respond in writing to any grievance or complaint within 15 days, advising the complainant of the resolution of the grievance or complaint or that a resolution is in process and that a response will be furnished in a timely manner. The health maintenance organization shall maintain records on all grievances received under this section until the Department has filed a report of examination on the grievances but no longer than seven years from the date of the grievance. Members shall be provided with a copy of the grievance procedures upon enrollment. (Added 1993, No. 30, § 6, eff. May 21, 1993.)