33-22-1702. Purpose. The purpose of this part is to allow a health care insurer providing disability insurance benefits to negotiate and contract with health care providers to:

Terms Used In Montana Code 33-22-1702

  • Contract: A legal written agreement that becomes binding when signed.
  • Health benefit plan: means the health insurance policy or subscriber arrangement between the insured or subscriber and the health care insurer that defines the covered services and benefit levels available. See Montana Code 33-22-1703
  • Health care insurer: means :

    (a)an insurer that provides disability insurance as defined in 33-1-207;

    (b)a health service corporation as defined in 33-30-101;

    (c)a fraternal benefit society as described in 33-7-105; or

    (d)any other entity regulated by the commissioner that provides health coverage except a health maintenance organization. See Montana Code 33-22-1703

  • Health care services: means health care services or products rendered or sold by a provider within the scope of the provider's license or legal authorization or services provided under Title 33, chapter 22, part 7. See Montana Code 33-22-1703
  • Provider: means an individual or entity licensed or legally authorized to provide health care services or services covered within Title 33, chapter 22, part 7. See Montana Code 33-22-1703

(1)provide health care services to its insureds or subscribers at a reduction in the fees customarily charged by the provider; or

(2)enter into agreements in which the participating providers accept negotiated fees as payment in full for health care services the health care insurer is obligated to provide or pay for under the health benefit plan.