Section 031-850-3 - Applicability and ScopeA. This rule shall apply to all health carriers, utilization review organizations and managed care plans as applicable. Section 7 is applicable to any carrier offering a managed care plan. Section 8 is applicable to any carrier that provides or performs utilization review services, any designee of the carrier or utilization review entity (URE) that performs utilization review functions on the carrier's behalf, and any URE performing utilization review on behalf of an employer. The requirements of section 8 are also applicable to all "adverse health care treatment decisions" rendered by or on behalf of "carriers" offering "health plans," as defined by 24-A M.R.S.A. §4301-A subsections 1, 3 and 7. Sections 9 and 10 are applicable to all carriers. The relationship of the appeals processes set forth in subsections 8(G) and 8 (G-1) to the grievance review procedures of section 9 is as follows. All adverse health care treatment decisions denying benefits to a covered person are subject to the appeals procedures set forth in subsections 8(G) and 8 (G-1). All requests for review of "adverse benefit determinations," other than "adverse health care treatment decisions," are subject to the grievance review procedures set forth in section 9. In the event of conflict between the provisions of this rule and those of any other rule promulgated by the Superintendent, the provisions of this rule shall be controlling. Any request for confidential handling of filings required by this rule must follow the confidentiality protocol established by the Superintendent and available from the Bureau of Insurance.B. All group and individual health plans under which covered services are subject to utilization review, pre-existing condition determinations, or determinations regarding experimental or investigational services, are subject to the disclosure requirements of subsection 8(I).C. All group and individual health plan contracts must incorporate the appeal and grievance procedure description required by subsection 10(B).02-031 C.M.R. ch. 850, § 3