33-31-306. Point-of-service option. (1) (a) A health maintenance organization that has at least 10,000 enrollees shall offer a point-of-service option benefit plan to each purchaser of a health care services agreement. The purchaser may accept or reject the addition of a point-of-service option to the health care services agreement.
(b) For the purposes of subsection (1)(a), an enrollee does not include an individual receiving medicaid services under the Montana medicaid program provided for in Title 53, chapter 6, or an individual participating in an approved medicare risk contract administered by a licensed health maintenance organization.
(2) Any difference in premium charged for the point-of-service option benefit plan compared to the premium for a standard health care services agreement may not exceed the expected cost to the insurer of benefits and expenses based on sound actuarial principles.
(3) This section may not be construed to permit a health maintenance organization to offer stand-alone indemnity insurance coverage.
History: En. Sec. 2, Ch. 165, L. 1997.
Structure Montana Code Annotated
Title 33. Insurance and Insurance Companies
Chapter 31. Health Maintenance Organizations
33-31-301. Evidence of coverage -- schedule of charges for health care services
33-31-302. Information to enrollees
33-31-305. Dentist participation as provider
33-31-306. Point-of-service option
33-31-307. Affiliation periods
33-31-308. through 33-31-310 reserved
33-31-311. Insurance producer license required
33-31-312. Prohibited practices
33-31-313. Premium increase restriction -- exception
33-31-314. through 33-31-320 reserved
33-31-321. Disclosure standards -- health maintenance organizations