Page:United States Statutes at Large Volume 124.djvu/164

124 STAT. 138 PUBLIC LAW 111–148—MAR. 23, 2010 ‘‘(2) provide notice to enrollees, in a culturally and linguis- tically appropriate manner, of available internal and external appeals processes, and the availability of any applicable office of health insurance consumer assistance or ombudsman estab- lished under section 2793 to assist such enrollees with the appeals processes; ‘‘(3) allow an enrollee to review their file, to present evi- dence and testimony as part of the appeals process, and to receive continued coverage pending the outcome of the appeals process; and ‘‘(4) provide an external review process for such plans and issuers that, at a minimum, includes the consumer protections set forth in the Uniform External Review Model Act promul- gated by the National Association of Insurance Commissioners and is binding on such plans.’’. SEC. 1002. HEALTH INSURANCE CONSUMER INFORMATION. Part C of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–91 et seq.) is amended by adding at the end the following: ‘‘SEC. 2793. HEALTH INSURANCE CONSUMER INFORMATION. ‘‘(a) IN GENERAL.—The Secretary shall award grants to States to enable such States (or the Exchanges operating in such States) to establish, expand, or provide support for— ‘‘(1) offices of health insurance consumer assistance; or ‘‘(2) health insurance ombudsman programs. ‘‘(b) ELIGIBILITY.— ‘‘(1) IN GENERAL.—To be eligible to receive a grant, a State shall designate an independent office of health insurance con- sumer assistance, or an ombudsman, that, directly or in coordination with State health insurance regulators and con- sumer assistance organizations, receives and responds to inquiries and complaints concerning health insurance coverage with respect to Federal health insurance requirements and under State law. ‘‘(2) CRITERIA.—A State that receives a grant under this section shall comply with criteria established by the Secretary for carrying out activities under such grant. ‘‘(c) DUTIES.—The office of health insurance consumer assist- ance or health insurance ombudsman shall— ‘‘(1) assist with the filing of complaints and appeals, including filing appeals with the internal appeal or grievance process of the group health plan or health insurance issuer involved and providing information about the external appeal process; ‘‘(2) collect, track, and quantify problems and inquiries encountered by consumers; ‘‘(3) educate consumers on their rights and responsibilities with respect to group health plans and health insurance cov- erage; ‘‘(4) assist consumers with enrollment in a group health plan or health insurance coverage by providing information, referral, and assistance; and ‘‘(5) resolve problems with obtaining premium tax credits under section 36B of the Internal Revenue Code of 1986. Grants. 42 USC 300gg–93. Notification.