<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".19" citation="COMAR 31.17.03.19" title_num="31" subtitle_num="17" chapter_num="03" heading="Complaints.">
  <paragraph num="A.">
    <text>The Plan administrator shall comply with the complaint process for adverse decisions and grievance decisions in Insurance Article, Title 15, Subtitle 10A, Annotated Code of Maryland.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The Plan administrator shall comply with the complaint process for coverage decisions in Insurance Article, Title 15, Subtitle 10D, Annotated Code of Maryland.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Members and providers shall have the same appeal rights regarding denials under the Plan as found under Insurance Article, Title 15, Subtitles 10A and 10D, Annotated Code of Maryland.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Complaints Regarding Eligibility Denials.</text>
    <paragraph num="(1)">
      <text>An individual shall file any initial complaints regarding an eligibility denial with the Plan administrator.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If the Plan administrator upholds its initial denial regarding an individual's eligibility for Plan coverage, the individual may appeal this denial to the Board or its designee.</text>
    </paragraph>
  </paragraph>
</regulation>