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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.
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.
A disability An insurer, health service corporation, or health maintenance
organization that issues policies, certificates, or membership contracts, or subscriber contracts that issues policies,
certificates, or contracts for delivery in this state , or that renews, extends, or modifies policies, certificates, or contracts on
or after October 1, 1995, shall include in the disability policies, certificates, or contracts definitions for terms that limit 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, or 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
These definitions must inform 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 such the additional charges may not be covered by the policy,
certificate, or membership contract, or subscriber contract."
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Latest Version of HB 156 (HB0156.ENR)
Processed for the Web on March 31, 1999 (1:31PM)
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