AN ACT REQUIRING INSURERS, HEALTH SERVICE CORPORATIONS, AND HEALTH MAINTENANCE ORGANIZATIONS THAT LIMIT HEALTH CARE SERVICE PAYMENTS BASED ON STANDARDS DESCRIBED AS USUAL AND CUSTOMARY, REASONABLE AND CUSTOMARY, PREVAILING FEE, ALLOWABLE CHARGES, A RELATIVE VALUE SCHEDULE, OR OTHER COMPARABLE TERMS TO INCLUDE IN THE POLICY, CERTIFICATE, MEMBERSHIP CONTRACT, OR SUBSCRIBER CONTRACT AN EXPLANATION OF HOW THE CHARGES ARE DETERMINED; AND AMENDING SECTION 33-15-308, MCA.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:

Section 1. Section 33-15-308, MCA, is amended to read:

"33-15-308. Explanation of charges. An insurer, health service corporation, or health maintenance organization that issues policies, certificates, membership contracts, or subscriber contracts for delivery in this state on or after January 1, 2000, and that limits payment of health care services based on standards described as usual and customary, reasonable and customary, prevailing fee, allowable charges, a relative value schedule, or other comparable terms shall include, displayed in the schedule page or elsewhere in the policy, certificate, membership contract, or subscriber contract:

(1) a definition of the term or terms and an explanation of how the limitation of payment based on the term or terms is derived;

(2) if the standard of the term or terms is derived by the use of a database, a description of the database reasonably calculated to inform the insured or certificate holder of the method used to define the geographic or demographic area from which the data used to determine the term or terms is derived; and

(3) a statement informing the insured that the insured's health care provider may charge more than the limits established by the defined terms and that the additional charges may not be covered by the policy, certificate, membership contract, or subscriber contract."

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I hereby certify that the within bill,

HB 0156, originated in the House.

Chief Clerk of the House

Speaker of the House

Signed this	day

of	, .

President of the Senate

Signed this	day

of	, .

HOUSE BILL NO. 156

INTRODUCED BY J. TROPILA

BY REQUEST OF THE STATE AUDITOR

AN ACT REQUIRING INSURERS, HEALTH SERVICE CORPORATIONS, AND HEALTH MAINTENANCE ORGANIZATIONS THAT LIMIT HEALTH CARE SERVICE PAYMENTS BASED ON STANDARDS DESCRIBED AS USUAL AND CUSTOMARY, REASONABLE AND CUSTOMARY, PREVAILING FEE, ALLOWABLE CHARGES, A RELATIVE VALUE SCHEDULE, OR OTHER COMPARABLE TERMS TO INCLUDE IN THE POLICY, CERTIFICATE, MEMBERSHIP CONTRACT, OR SUBSCRIBER CONTRACT AN EXPLANATION OF HOW THE CHARGES ARE DETERMINED; AND AMENDING SECTION 33-15-308, MCA.