33-22-1705. Incentives in health benefit plans, MCA

Montana Code Annotated 2019

TITLE 33. INSURANCE AND INSURANCE COMPANIES

CHAPTER 22. DISABILITY INSURANCE

Part 17. Preferred Provider Agreements

Incentives In Health Benefit Plans

33-22-1705. Incentives in health benefit plans. (1) A health care insurer may issue a policy or a health benefit plan that provides for incentives for covered persons to use the health care services of preferred providers. The policy or health benefit plan must contain at least:

(a) a provision that if a covered person receives emergency care for services specified in the preferred provider agreement and cannot reasonably reach a preferred provider, the care rendered during the course of the emergency will be reimbursed as though the covered person had been treated by a preferred provider; and

(b) a provision that clearly identifies the difference in benefit levels for health care services of a preferred provider and benefit levels for the same health care services of a nonpreferred provider.

(2) A health care insurer may not require hospital staff privileges as criteria for designation as a preferred provider in a preferred provider agreement.

History: En. Sec. 5, Ch. 638, L. 1987.