(1) (a) A health maintenance organization shall provide its subscribers with a list of the names and locations of all of its providers no later than the time of enrollment or the time the contract and evidence of coverage are issued and upon request thereafter. If a provider is no longer affiliated with a health maintenance organization, the health maintenance organization shall provide notice of such change to its affected subscribers in a timely manner. Subject to the approval of the commissioner, a health maintenance organization may provide its subscribers with a list of providers or provider groups for a segment of the service area.   However, a health maintenance organization shall make a list of all providers available to subscribers upon request.

(b) Any list of providers must contain a notice regarding the availability of the listed primary care physicians. The notice must be in not less than 12-point type and be placed in a prominent place on the list of providers. The notice must contain the following or similar language: "Enrolling in [name of health maintenance organization] does not guarantee services by a particular provider on this list. If you wish to be sure of receiving care from specific providers listed, you should contact those providers to be sure that they are accepting additional patients for [name of health maintenance organization]."

(2) A health maintenance organization shall provide its subscribers with a description of its service area no later than the time of enrollment or the time the contract and evidence of coverage is issued and upon request thereafter. If the description of the service area is changed, the health maintenance organization shall provide at such time a new description of the service area to its subscribers.

(3) A health maintenance organization may require copayments of enrollees as a condition for the receipt of specific health care services. Copayments for basic health care services must be shown in the contract and evidence of coverage. Copayments and deductibles are the only charges that a health maintenance organization may assess to subscribers for basic and supplemental health care services.

(4) (a) A health maintenance organization must establish and maintain a complaint system to provide reasonable procedures for the prompt and effective resolution of written complaints.

(b) A health maintenance organization shall provide complaint forms to be given to enrollees who wish to register written complaints. The forms must include the address and telephone number to which complaints must be directed and must also specify any required time limits imposed by the health maintenance organization.

(c) The complaint system must require the health maintenance organization to acknowledge a complaint in writing within 10 days and resolve or make a final determination of the complaint within 60 days from the date the complaint is registered. This period may be extended if

(i) there is a delay in obtaining the documents or records necessary for resolving the complaint; or

(ii) the health maintenance organization and the enrollee mutually agree in writing.

(d) Pending the resolution of a written complaint filed by a subscriber or enrollee, coverage may not be terminated for any reason which is the subject of the written complaint, unless the health maintenance organization has, in good faith, made a reasonable effort to resolve the written complaint through its complaint system and coverage is being terminated as provided for in subsection (2) of ARM 6.6.2507.

(e) If an enrollee's complaint and grievance may be resolved through a specified arbitration agreement, the enrollee shall be advised in writing of his rights and duties under the agreement at the time the complaint is registered. An agreement must be accompanied by a statement setting forth in writing the terms and conditions of binding arbitration. A health maintenance organization that makes binding arbitration a condition of enrollment must fully disclose this requirement to its enrollees in the contract and evidence of coverage.