TITLE 41

INSURANCE

CHAPTER 34

HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS

41-3413.  Services and benefits which may be provided professional service corporations. (1) A professional service corporation shall have the right to provide to its subscribers part or all of the following services and benefits only:

(a)  Professional services furnished to the subscriber by one (1) or more specified categories of participant licensees, as such categories are referred to in section 41-3403(9), Idaho Code, and subject to the requirements of section 41-3408(3), Idaho Code, (qualifications for authority) as to each such category;

(b)  Indemnity in reasonable amounts with respect to professional services and drugs (under subscribers’ contracts providing for services of participant licensee pharmacists) furnished to the subscriber by nonparticipant licensees of the same category or categories as participant licensees of the service corporation, but subject to section 41-3408(3), Idaho Code, (qualifications for authority);

(c)  Indemnity in reasonable amounts with respect to hospital services furnished the subscriber while under the care and treatment of a licensee entitled to practice in such hospital;

(d)  Indemnity in reasonable amounts with respect to appliances, prosthetics and similar devices and replacements, and ambulance, x-ray, physiotherapy, and similar services; and

(e)  Indemnity in reasonable amounts with respect to services rendered to the subscriber by licensees of a category or categories specified in the subscriber’s contract including any category of licensee defined in section 41-3403(9), Idaho Code, or rendered by other persons specified in the subscriber’s contract, duly licensed by the state to engage in any health care profession or practice. The portion of the total charges to subscribers for such coverage as is authorized by this paragraph shall not exceed one-third (1/3) of the total charges to all subscribers made by the service corporation for all services and benefits rendered in any calendar year.

(2)  This section shall not be deemed to prohibit such a corporation from acting as compensated servicing agent as to health care services to be provided by any public agency or under agreements between other parties not solicited by such corporation.

History:

[41-3413, added 1961, ch. 330, sec. 771, p. 645; am. 1971, ch. 252, sec. 8, p. 1008; am. 2021, ch. 321, sec. 31, p. 971.]