The health provider cooperative shall file each contract between the cooperative and a purchaser with the commissioner. The commissioner shall disapprove any contract:

Terms Used In North Dakota Code 26.1-49-05

  • Contract: A legal written agreement that becomes binding when signed.
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • year: means twelve consecutive months. See North Dakota Code 1-01-33

1.    In which the consideration paid for health services is unreasonably high in relationship to the services provided.

2.    That fails to include evidence of the specific procedures used to inform prospective enrollees of any limitations imposed on the enrollee’s right to receive care from a health provider of the enrollee’s choice.

     3.    Under which a health provider cooperative assumes a corridor of risk greater than fifteen percent in its first year of operation, or greater than thirty percent in any year thereafter.

Any actuarial costs incurred by the department in review of that filing must be borne by the cooperative. The commissioner may adopt rules implementing this section.

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