26.1-53 Discount Medical Plans

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CHAPTER 26.1-53DISCOUNT MEDICAL PLANS26.1-53-01. Definitions. As used in this chapter, unless the context otherwise requires:1.&quot;Discount medical plan&quot; means any card, program, device, or mechanism that is not<br>insurance which purports to offer discounts or access to discounts from a provider<br>without recourse to the discount medical plan.2.&quot;Discount medical plan organization&quot; means a person that, in exchange for fees,<br>dues, charges, or other consideration, provides access for plan members to a<br>discount medical plan.3.&quot;Marketer&quot; means a person that markets, promotes, sells, or distributes a discount<br>medical plan.4.&quot;Medical services&quot; means any care, service, or treatment of illness or dysfunction of,<br>or injury to, the human body, including physician care, inpatient care, hospital<br>surgical services, emergency services, ambulance services, dental care services,<br>vision care services, mental health services, substance abuse services, chiropractic<br>services, podiatric care services, and laboratory services. The term does not include<br>pharmaceutical supplies or prescriptions.5.&quot;Member&quot; means any person that pays fees, dues, charges, or other consideration<br>for the right to receive the benefits of a discount medical plan.6.&quot;Provider&quot; means any person that is contracted, directly or indirectly, with a discount<br>medical plan organization to provide medical services to members.7.&quot;Provider network&quot; means a person that negotiates on behalf of more than one<br>provider with a discount medical plan organization to provide medical services to<br>members.26.1-53-02.Prohibited activities of a discount medical plan organization ormarketer. A discount medical plan organization may not:1.Use in its advertisements, marketing material, brochures, and discount cards the<br>term &quot;insurance&quot; except as otherwise provided under this chapter.2.Use in its advertisements, marketing material, brochures, and discount cards the<br>terms &quot;health plan&quot;, &quot;coverage&quot;, &quot;copay&quot;, &quot;copayments&quot;, &quot;preexisting conditions&quot;,<br>&quot;guaranteed issue&quot;, &quot;premium&quot;, &quot;PPO&quot;, &quot;preferred provider organization&quot;, or other<br>terms in a manner that could reasonably mislead a person into believing the<br>discount medical plan is insurance.3.Pay providers any fees for medical services, unless the organization is an authorized<br>third-party administrator.26.1-53-03. Disclosures.1.A discount medical plan organization or marketer shall disclose clearly and<br>conspicuously in writing to any prospective member and on any advertisements,<br>marketing materials, or brochures relating to a discount medical plan:a.That the plan is not an insurance policy.b.That the plan provides discounts at certain health care providers for medical<br>services.Page No. 1c.That the plan member is obligated to pay for all health care services but will<br>receive a discount from those health care providers that have contracted with<br>the discount medical plan organization.d.The name, address, and telephone number of the discount medical plan<br>organization and the marketer.e.The cancellation and refund rights provided under section 26.1-53-08.2.Any advertisements, marketing materials, or brochures relating to a discount<br>medical plan which are transmitted to the public through the internet or television<br>must state that the plan is not an insurance policy and that the plan provides<br>discounts at certain health care providers for medical services.3.The discount medical plan organization or marketer in solicitations conducted<br>through telemarketing shall disclose orally to prospective members the required<br>disclosures provided under subsection 1.26.1-53-04. Provider agreements.1.All providers offering medical services to members under a discount medical plan<br>shall provide such services pursuant to a written agreement with the discount<br>medical plan organization. The agreement may be entered directly by the provider<br>or by a provider network to which the provider belongs.2.A provider agreement must provide the following:a.A list of the services and products to be provided at a discount.b.The amount or amounts of the discounts or, alternatively, a fee schedule that<br>reflects the provider's discounted rates.c.That the provider will not charge members more than the discounted rates.3.A provider agreement between a discount medical plan organization and a provider<br>network must require that the provider network have written agreements with the<br>provider network's providers which:a.Comply with subsection 2.b.Authorize the provider network to contract with the discount medical plan<br>organization on behalf of the provider.c.Require the provider network to maintain an up-to-date list of the provider<br>network's contracted providers and to provide that list on a quarterly basis to<br>the discount medical plan organization.4.The discount medical plan organization shall maintain a copy of each active provider<br>agreement and provide copies of the agreements to the commissioner, upon written<br>request.26.1-53-05.Provider name listing.Each discount medical plan organization shallmaintain an up-to-date list of the names and addresses of the providers with which the discount<br>medical plan organization has contracted, and the discounts provided by those providers, on a<br>website on the internet, the address of which must be prominently displayed on all the discount<br>medical plan organization advertisements, marketing materials, brochures, and discount cards.<br>This section applies to those providers with which the discount medical plan organization has<br>contracted directly, as well as those that are members of a provider network with which the<br>discount medical plan organization has contracted.Page No. 226.1-53-06. Marketing of discount medical plans.1.All advertisements, marketing materials, brochures, and discount cards used by<br>marketers must be approved in writing for such use by the discount medical plan<br>organization.2.The discount medical plan organization must have an executed written agreement<br>with a marketer before the marketer's marketing, promoting, selling, or distributing<br>the discount medical plan.26.1-53-07. Bundling discount medical plans with insurance products prohibited.If a marketer or discount medical plan organization solicits, markets, or sells a discount medical<br>plan together with any insurance product, the marketer or organization shall disclose clearly and<br>conspicuously that the plan is not insurance.26.1-53-08. Cancellation and refunds.1.A discount medical plan shall permit members to cancel at any time. If cancellation<br>occurs within thirty days of the member receiving written notice of cancellation rights,<br>the discount medical plan shall provide within thirty days of notice of cancellation a<br>full refund to the canceling member, except for a nominal fee associated with the<br>enrollment cost up to a maximum of fifty dollars. In the event of cancellation of the<br>membership by either party, if a discount medical plan charges for a time period in<br>excess of one month, the plan shall make a pro rata refund to the member.2.The discount medical plan organization or marketer shall provide the member with<br>written notice of cancellation rights within ten business days of purchase. The notice<br>of cancellation rights must be clearly and conspicuously disclosed and must include<br>instructions for the member to cancel the plan.The instructions must be madeavailable to the commissioner upon request.3.Cancellation occurs when notice of cancellation is given to the discount medical plan<br>organization or marketer.4.Notice of cancellation is deemed given when delivered in hand, deposited in a<br>mailbox, properly addressed and postage prepaid, or e-mailed to the e-mail address<br>of the discount medical plan organization or marketer.26.1-53-09. Enforcement - Powers - Remedies - Penalties. The commissioner or theattorney general may enforce this chapter. The attorney general, in enforcing this chapter, has<br>all the powers provided in this chapter or chapter 51-15 and may seek all remedies in this<br>chapter or chapter 51-15. A violation of this chapter is deemed a violation of chapter 51-15. The<br>remedies, duties, prohibitions, and penalties of this chapter are not exclusive and are in addition<br>to all other causes of action, remedies, and penalties under chapter 51-15, or otherwise provided<br>by law.Page No. 3Document Outlinechapter 26.1-53 discount medical plans