Section 7. (a) A carrier shall provide to at least one adult insured in each household upon enrollment, and to a prospective insured upon request, the following information:
(1) a list of health care providers in the carrier’s network, organized by specialty and by location and summarizing for each such provider the method used to compensate or reimburse such provider; provided, however, that nothing in this clause shall be construed to require disclosure of the specific details of any financial arrangements between a carrier and a provider; provided, further, that if any specific providers or type of providers requested by an insured are not available in said network, or are not a covered benefit, such information shall be provided in an easily obtainable manner;
(2) a statement that physician profiling information, so-called, may be available from the board of registration in medicine;
(3) a summary description of the process by which clinical guidelines and utilization review criteria are developed;
(4) the voluntary and involuntary disenrollment rate among insureds of the carrier;
(5) a statement that insureds have the opportunity to obtain health care services for an emergency medical condition, including the option of calling the local pre-hospital emergency medical service system, whenever the insured is confronted with an emergency medical condition which in the judgment of a prudent layperson would require pre-hospital emergency services; and
(6) a statement that the information specified in paragraph (b) is available to the insured or prospective insured from the office of patient protection in the department of public health.
(b) A carrier shall provide all of the information required under section 6 and subsection (a) of this section to the office of patient protection in the department of public health and, in addition, shall provide to said office the following information:
(1) a list of sources of independently published information assessing insured satisfaction and evaluating the quality of health care services offered by the carrier;
(2) the percentage of physicians who voluntarily and involuntarily terminated participation contracts with the carrier during the previous calendar year for which such data has been compiled and the three most common reasons for voluntary and involuntary physician disenrollment;
(3) the percentage of premium revenue expended by the carrier for health care services provided to insureds for the most recent year for which information is available; and
(4) a report detailing, for the previous calendar year, the total number of: (i) filed grievances, grievances that were approved internally, grievances that were denied internally, and grievances that were withdrawn before resolution; and (ii) external appeals pursued after exhausting the internal grievance process and the resolution of all such external appeals. The report shall identify for each such category, to the extent such information is available, the demographics of such insureds, which shall include, but need not be limited to, race, gender and age.