(NAR) VOL. 29 NO. 1/ JANUARY - MARCH 18
1. All complaints filed against an HMO received by the Insurance Commission, including its District Offices, shall be:This Circular Letter shall take effect immediately. For strict compliance.a. Endorsed to the AHMOPI’s grievance machinery involving their members; or2. Complaints against HMOs, which are non-members, shall be handled by the
b. Endorsed to PAHMOC’s grievance machinery involving their members.
Insurance Commission through Public Assistance and Mediation Division;
3. The AHMOPI and the PAHMOC are hereby authorized to conduct mediation proceedings on all complaints referred/endorsed by this Commission;
4. The AHMOPI and the PAHMOC, are hereby enjoined to conclude all mediation proceedings within thirty (30) days from receipt of the endorsement of the complaint from this Commission;
5. Should there be settlement between the parties, the endorsee is directed to file a report, together with the necessary documents, within five (5) days from the settlement of the complaint/case addressed to the Insurance Commission;
6. In the event that the parties fail to reach an amicable settlement, the endorsee shall forward the complaint, including all records pertaining thereto, within five (5) days from termination of the mediation conference, to this Commission for appropriate action in accordance with existing rules and regulations; and
7. The IC, through the PAMD, shall conduct the mediation conference of the cases of failed mediation mentioned in the immediately preceding paragraph forwarded by either AHMOPI or PAHMOC in accordance with existing rules and regulations.