TITLE 41

INSURANCE

CHAPTER 34

HOSPITAL AND PROFESSIONAL SERVICE CORPORATIONS

41-3416.  Hospital service agreements. (1) A hospital service corporation shall enter into service agreements with only hospitals duly approved or licensed by the state of Idaho.

(2)  Each such service agreement shall require the participant hospital to furnish to subscribers of the service corporation the hospital services which are, under the subscriber’s contract, to be furnished by participant hospitals; and this obligation so to furnish such service, as provided for in the subscriber’s contract, shall be a direct obligation of the participant hospitals to the subscribers as well as to the service corporation.

(3)  Each such service agreement shall further effectively in substance provide that:

(a)  The participant hospital shall be compensated for services rendered to a subscriber in accordance with a schedule of charges contained in the agreement or attached to and made a part of the agreement, and that the hospital shall not request or receive from the service corporation any compensation for such services which is not in accord with such schedule.

(b)  Compensation for services may be prorated and settled under the circumstances and in the manner referred to in section 41-3431.

(c)  If the participant hospital withdraws from the agreement, such withdrawal shall not be effective as to any subscriber’s contract in force on the date of such withdrawal until the termination of the subscriber’s contract or the next following anniversary of the subscriber’s contract, whichever date is the earlier.

(4)  The service corporation shall terminate the service agreement as to a particular participant hospital, in addition to other bases of termination provided for in the agreement, if it is determined that the hospital has knowingly charged or attempted to charge the service corporation for any service not actually rendered, or has knowingly violated any material provision of the service agreement.

(5)  The proposed form of any such service agreement and of any standard riders and endorsements thereto shall be filed with the director and be subject to his approval, as provided in section 41-3419.

History:

[41-3416, added 1961, ch. 330, sec. 774, p. 645.]