41-2872. HEALTH CARE PROVIDER CONTRACTS — GRIEVANCE PROCEDURE. (1) Any stock or mutual insurer (hereinafter insurance company) issuing benefits pursuant to the provisions of this chapter shall be ready and willing at all times to enter into health care provider service contracts with all qualified health care providers of the category or categories which are necessary to provide the health care services covered by the insurance company’s policy of insurance if such health care providers: are qualified under the laws of the state of Idaho, desire to become participant health care providers of the insurance company, meet the requirements of the insurance company, and practice within the general area served by the insurance company.
(2) Nothing in this section shall preclude an insurance company from refusing to contract with a health care provider who is unqualified or who does not meet the terms and conditions of the participating provider contract of the insurance company or from terminating or refusing to renew the contract of a participating health care provider who is unqualified or who does not comply with, or who refuses to comply with, the terms and conditions of the participating health care provider contract including, but not limited to, practice standards and quality requirements. The contract shall provide for written notice to the participating health care provider setting forth any breach of contract for which the insurance company proposes that the contract be terminated or not renewed and shall provide for a reasonable period of time for the participating health care provider to cure such breach prior to termination or nonrenewal. If the breach has not been cured within such period of time the contract may be terminated or not renewed. Provided however, that if the breach of contract for which the insurance company proposes that the contract be terminated or not renewed is a willful breach, fraud or a breach which poses an immediate danger to the public health or safety, the contract may be terminated or not renewed immediately.
(3) Every insurance company issuing benefits pursuant to this chapter shall establish a grievance system for health care providers. Such grievance system shall provide for arbitration according to chapter 9, title 7, Idaho Code, or for such other system which provides reasonable due process provisions for the resolution of grievances and the protection of the rights of the parties.
(4) Subsections (1) and (2) of this section shall apply to health care provider participation contracts entered into after July 1, 1994.
History:
[41-2872, added 1994, ch. 275, sec. 1, p. 853.]
Structure Idaho Code
Chapter 28 - ORGANIZATION AND CORPORATE PROCEDURES OF STOCK AND MUTUAL INSURERS
Section 41-2801 - SCOPE OF CHAPTER.
Section 41-2802 - “STOCK” INSURER — “MUTUAL” INSURER — DEFINITIONS.
Section 41-2803 - APPLICABILITY OF GENERAL CORPORATION STATUTES.
Section 41-2804 - INCORPORATION.
Section 41-2805 - FILING OF ARTICLES.
Section 41-2809 - INVESTIGATION OF PROPOSED ORGANIZATION.
Section 41-2818 - QUALIFICATION FOR INITIAL CERTIFICATE OF AUTHORITY — STOCK INSURERS.
Section 41-2820 - INITIAL QUALIFICATIONS — DOMESTIC MUTUALS.
Section 41-2822 - APPLICATIONS FOR INSURANCE IN FORMATION OF MUTUAL INSURER.
Section 41-2823 - FORMATION OF MUTUALS — TRUST DEPOSIT OF PREMIUMS — ISSUANCE OF POLICIES.
Section 41-2824 - FORMATION OF MUTUALS — FAILURE TO QUALIFY.
Section 41-2825 - ADDITIONAL KINDS OF INSURANCE — MUTUALS.
Section 41-2826 - AMENDMENT OF ARTICLES OF INCORPORATION — STOCK INSURERS.
Section 41-2827 - AMENDMENT OF ARTICLES OF INCORPORATION — MUTUAL INSURER.
Section 41-2828 - INSURANCE BUSINESS EXCLUSIVE.
Section 41-2829 - MEMBERSHIP IN MUTUALS.
Section 41-2830 - BY-LAWS OF MUTUAL.
Section 41-2831 - RIGHTS OF MUTUAL MEMBERS IN GENERAL.
Section 41-2832 - MEETINGS OF MEMBERS OF MUTUAL INSURER.
Section 41-2833 - SPECIAL MEETINGS OF MEMBERS OF MUTUAL INSURER.
Section 41-2834 - VOTING RIGHTS OF MUTUAL MEMBERS.
Section 41-2836 - NOTICE OF CHANGE OF DIRECTORS OR OFFICERS.
Section 41-2837 - PROHIBITED PECUNIARY INTEREST OF OFFICIALS.
Section 41-2838 - MANAGEMENT AND EXCLUSIVE AGENCY CONTRACTS.
Section 41-2839 - HOME OFFICE — RECORDS — ASSETS — PENALTY FOR UNLAWFUL REMOVAL.
Section 41-2840 - VOUCHERS FOR EXPENDITURES.
Section 41-2841 - BORROWED SURPLUS.
Section 41-2842 - PARTICIPATING POLICIES.
Section 41-2843 - DIVIDENDS TO STOCKHOLDERS.
Section 41-2844 - DIVIDENDS TO POLICY HOLDERS.
Section 41-2845 - ILLEGAL DIVIDENDS — PENALTY.
Section 41-2846 - CONTINGENT LIABILITY OF MUTUAL MEMBERS.
Section 41-2847 - LEVY OF CONTINGENT LIABILITY.
Section 41-2848 - ENFORCEMENT OF CONTINGENT LIABILITY.
Section 41-2849 - NONASSESSABLE POLICIES — MUTUAL INSURERS.
Section 41-2850 - NONASSESSABLE POLICIES — REVOCATION OF AUTHORITY.
Section 41-2851 - SOLICITATIONS IN OTHER STATES.
Section 41-2852 - IMPAIRMENT OF CAPITAL OR ASSETS.
Section 41-2853 - ASSESSMENT OF STOCKHOLDERS OR MEMBERS.
Section 41-2854 - MUTUALIZATION OF STOCK INSURERS.
Section 41-2854A - MUTUALIZATION OF SERVICE CORPORATIONS.
Section 41-2855 - CONVERSION OF MUTUAL INSURER TO STOCK INSURER.
Section 41-2856 - MERGERS AND CONSOLIDATIONS OF STOCK INSURERS.
Section 41-2857 - MERGERS AND CONSOLIDATIONS OF MUTUAL INSURERS.
Section 41-2858 - BULK REINSURANCE — MUTUAL INSURERS.
Section 41-2859 - MUTUAL MEMBER’S SHARE OF ASSETS ON LIQUIDATION.
Section 41-2860 - EQUITY SECURITIES OF DOMESTIC STOCK INSURANCE COMPANIES — STATEMENTS OF OWNERSHIP.
Section 41-2861 - RECOVERY OF PROFITS RESULTING FROM UNFAIR USE OF INFORMATION.
Section 41-2862 - RESTRICTIONS ON SALE OF EQUITY SECURITIES.
Section 41-2863 - PURCHASES AND SALES WHICH ARE EXEMPT.
Section 41-2864 - FOREIGN OR DOMESTIC ARBITRAGE TRANSACTIONS EXEMPT.
Section 41-2865 - “EQUITY SECURITY” DEFINED.
Section 41-2866 - CONDITIONS EXEMPTING EQUITY SECURITIES.
Section 41-2867 - RULES AND REGULATIONS.
Section 41-2868 - PROXY REGULATIONS.
Section 41-2870 - DEFINITIONS.
Section 41-2871 - USE OF BOOK-ENTRY SYSTEMS.
Section 41-2872 - HEALTH CARE PROVIDER CONTRACTS — GRIEVANCE PROCEDURE.
Section 41-2873 - BEST PRICE — MOST FAVORED NATIONS CLAUSE PROHIBITED.