Section 415-I:9 Provider Agreements; Participating Provider Listing Requirements.
I. (a) A discount medical plan organization shall have a written provider agreement with all participating providers. The written provider agreement shall be entered into directly with the provider or indirectly with a provider network to which the provider belongs.
(b) An agreement between a discount medical plan organization and a participating provider shall include the following:
(1) A list of the medical or ancillary services and products to be provided at a discount;
(2) The amount or amounts of the discounts or, alternatively, a fee schedule that reflects the provider's discounted rates; and
(3) A statement that the provider will not charge members more than the discounted rates.
(c) An agreement between a discount medical plan organization and a provider network shall require that the provider network have written agreements with its providers that:
(1) Contain the provisions described in subparagraph (b);
(2) Authorize the provider network to contract with the discount medical plan organization on behalf of the provider; and
(3) Require the provider network to maintain an up-to-date list of its contracted providers and to provide the list on a monthly basis to the discount medical plan organization.
(d) An agreement between a discount medical plan organization and an entity that contracts with a provider network shall require that the entity, in its contract with the provider network, require the provider network to have written agreements with its providers that comply with subparagraph (c).
(e) The discount medical plan organization shall maintain a copy of each active provider agreement into which it has entered.
II. Each discount medical plan organization shall maintain on an Internet website page an up-to-date list of the names and addresses of the providers with which it has contracted directly or through a provider network. The Internet website address shall be prominently displayed on all of its advertisements, marketing materials, brochures, and discount medical plan cards.
Source. 2008, 206:1, eff. Jan. 1, 2009.