33-22-1705. Incentives in health benefit plans.
154 words·~1 min read·
/mt/title-33/chapter-22/part-17/33-22-1705·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
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.