TITLE 41

INSURANCE

CHAPTER 34

HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS

41-3417.  Subscriber’s contracts. (1) Each subscriber’s contract hereafter issued by a service corporation shall constitute a direct obligation of the participant licensees and/or participant hospitals to render the professional or hospital services, as the case may be, as agreed to be rendered by such participants in the subscriber’s contract.

(2)  Each such subscriber’s contract or certificate shall in adequate detail set forth provisions from which can be readily determined:

(a)  The services to which the subscriber is entitled from participant licensees and/or participant hospitals, as the case may be;

(b)  The benefits, if any, to which the subscriber is entitled on an indemnity basis, consistent with sections 41-3413 and 41-3414, Idaho Code, and with this chapter;

(c)  The periodic subscription charge, rate or fee payable by or as to the subscriber; or, if not so expressed and such charge, rate or fee is subject to change, the subscriber’s contract shall require that not less than thirty (30) days’ written notice of the new charge, rate or fee shall be given to the subscriber and/or his remitting agent before the change is effective;

(d)  The date when the respective services and benefits become available to the subscriber, date of expiration of the contract, and the terms, if any, under which the contract may be continued or renewed;

(e)  All other terms and conditions of the agreement between the parties consistent with the provisions of this chapter; and

(f)  That the subscriber’s contract and riders and indorsements thereon or thereto, together with application therefor, if any, signed by the subscriber, and identification issued to the subscriber, shall constitute the entire contract between the parties.

(3)  No such contract shall restrict the subscriber’s right to free choice of hospital or licensee, within the category or categories provided for in the contract. Such contract may provide lesser benefits for services rendered by nonparticipant licensees and/or nonparticipant hospitals than those provided by participant licensees and/or participant hospitals. Provided however, such contract shall permit a subscriber to direct that the payment of dental care benefits to which the subscriber is entitled, pursuant to the contract, be made in the name of the nonparticipant licensee providing covered dental care services authorized by the subscriber’s contract.

(4)  All exceptions and exclusions in the contract shall be printed and otherwise set forth as prominently as the services or benefits to which they apply.

(5)  No provision in this code shall be construed to prohibit a service corporation from issuing contracts to groups of persons under a master contract. In this event, however, each subscriber covered under the master contract shall be issued an individual certificate which shall set forth in adequate detail the provisions itemized in subsection (2) above.

(6)  All proposed forms of subscriber’s contracts shall be filed with the director and be subject to his approval, as provided in section 41-3419, Idaho Code.

History:

[41-3417, added 1961, ch. 330, sec. 775, p. 645; am. 1967, ch. 399, sec. 9, p. 1194; am. 1971, ch. 252, sec. 11, p. 1008; am. 1992, ch. 185, sec. 1, p. 576.]