Requirements for approval.

To obtain approval of a system for resolving complaints of insureds concerning health care services covered by an insurer from the Commissioner as required pursuant to NRS 695B.380 , an insurer must: 1. Demonstrate that the system will resolve oral and written complaints concerning: (a) Payment or reimbursement for covered health care services; (b) The availability, delivery or quality of covered health care services, including, without limitation, an adverse determination made pursuant to utilization review; and (c) The terms and conditions of the health care plan of insureds. 2. Submit to the Division: (a) The name and title of the employee responsible for the system; (b) A description of the procedure used to notify an insured of the decision regarding his or her complaint; and (c) A copy of the explanation of rights and procedures which is to be provided to insureds pursuant to NRS 695B.400 .