(1)(a) A discount plan
organization shall have a written health care provider agreement
with all health care providers for whose health care services it
provides access to a discount to its members. The written health
care provider agreement may be entered into directly with the
health care provider or indirectly with a health care provider
network to which the health care provider belongs.
(b) A health care provider agreement between a discount plan
organization and a health care provider must provide the
following:
(i) A list of the health care services and products to be
provided at a discount;
(ii) The amount or amounts of the discounts or,
alternatively, a fee schedule that reflects the health care
provider's discounted rates; and
(iii) That the health care provider may not charge members
more than the discounted rates.
(c) A health care provider agreement between a discount plan
organization and a health care provider network must require that
the health care provider network have written agreements with its
health care providers that:
(i) Contain the provisions described in (b) of this
subsection;
(ii) Authorize the health care provider network to contract
with the discount plan organization on behalf of the health care
provider; and
(iii) Require the health care provider network to maintain
an up-to-date list of its contracted health care providers and to
provide the list on a monthly basis to the discount plan
organization.
(d) A health care provider agreement between a discount plan
organization and an entity that contracts with a health care
provider network must require that the entity, in its contract
with the health care provider network, require the health care
provider network to have written agreements with its health care
providers that comply with (c) of this subsection.
(e) The discount plan organization shall maintain a copy of
each health care provider agreement into which it has entered and
shall promptly furnish a copy of each agreement to the
commissioner when requested.
(2)(a) Each discount plan organization shall maintain on an
internet web site a list of the names and addresses of the health
care providers with which it has a current provider agreement
directly or through a health care provider network. This list
must be updated every thirty days. The internet web site address
must be prominently displayed on all of its advertisements,
marketing materials, brochures, and discount plan cards.
(b) This subsection applies to those health care providers
with which the discount plan organization has a current provider
agreement directly as well as those health care providers that
are members of a health care provider network with which the
discount plan organization has a current provider agreement.
[2009 c 175 § 10.]