Mont. Code Ann. § 33-22-1705. Incentives in health benefit plans: Preferred Provider Agreements Act – Montana
Status: Enacted Year Enacted: 1987
A health care insurer may issue a policy or a health benefit plan that provides for incentives for covered persons to use the health care services of preferred providers. The policy or health benefit plan …
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Mont. Code Ann. § 33-22-1706. Permissible and mandatory provisions in provider agreements, insurance policies, and subscriber contracts: Preferred Provider Arrangements Act – Montana
Status: Enacted Year Enacted: 1987
A provider agreement, insurance policy, or suscriber contract issued or delivered in this state may contain certain other components designed to control the cost and improve the quality of care for inusreds and subscribers.
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Mont. Code Ann. § 39-71-1101. Choice of health care provider by worker — insurer designation or approval of treating physician or referral to managed care or preferred provider organization — payment terms — definition: Treatment by Designated Providers – Montana
Status: Enacted Year Enacted: 1993
Prior to the insurer’s designation or approval of a treating physician as provided in subsection (2) or a referral to a managed care organization or preferred provider organization as provided in subsection (8), a worker …
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Mont. Code Ann. § 39-71-1102. Preferred provider organizations — establishment — limitations: Treatment by Designated Providers – Montana
Status: Enacted Year Enacted: 1993
To promote cost containment, insurers are encouraged to develop preferred provider organizations.
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Mont. Code Ann. § 39-71-1103. Workers’ compensation managed care: Treatment by Designated Providers – Montana
Status: Enacted Year Enacted: 1993
A managed care system is a program organized to serve the medical needs of injured workers in an efficient and cost-effective manner by managing the delivery of medical services for a defined population of injured …
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N.C. Gen. Stat. § 131E-290. Prohibited practice: Provider Sponsored Organization Licensing – North Carolina
Status: Enacted Year Enacted: 1998
Describes prohibited practices for provider sponsored organization.
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N.D. Cent. Code § 26.1-08-03.1. Operation of the association: Comprehensive Health Association – North Dakota
Status: Enacted Year Enacted: 2003
A comprehensive health association may design, utilize, contract, or otherwise arrange for the delivery of cost-effective health care services, including establishing or contracting with preferred provider organizations, health maintenance organizations, and other limited network provider …
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N.D. Cent. Code § 26.1-47-02. Preferred provider arrangements: Preferred Provider Organizations – North Dakota
Status: Enacted Year Enacted: 1987
Requires that a health care insurer file all preferred provider arrangements with the commissioner of insurance within ten days of implementing the arrangements, which are subject to commissioner’s approval. Preferred provider arrangements may not restrict …
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N.D. Cent. Code § 26.1-47-03. Health benefits plans: Preferred Provider Organizations – North Dakota
Status: Enacted Year Enacted: 1987
Health care insurers may issue policies or subscriber agreements which provide for incentives for covered persons to use the health care services of preferred providers. If a preferred provider is too far away from a …
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N.D. Cent. Code § 26.1-47-04. Preferred provider participation requirements: Preferred Provider Organizations – North Dakota
Status: Enacted Year Enacted: 1987
Health care insurers may place reasonable limits on the number of classes of preferred providers which satisfy the standards set forth by the health care insurer, provided that there be no discrimination against any providers …
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N.H. Rev. Stat. Ann. §§ 420-J:1 through 420-J:3: Managed Care Law – New Hampshire
Status: Enacted Year Enacted: 1997
Provisions provide the purpose and intent, the applicability and scope, and definitions for sections 420-J:1 through 420-J:14.
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N.J. Rev. Stat. § 17B:27A-19.11. Carriers writing small employer health benefits plans; network of providers: Individual Health Insurance Reform – New Jersey
Status: Enacted Year Enacted: 2001
States that a carrier may also offer one or more of the plans through its network of providers, with no reimbursement for out of network benefits other than emergency care, urgent care, and continuity of …
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N.J. Rev. Stat. § 17B:27A-4.7. Carriers writing individual health benefits plans; network of providers: Individual Health Insurance Reform – New Jersey
Status: Enacted Year Enacted: 2001
States that a carrier may also offer one or more of the plans through its network of providers, with no reimbursement for out of network benefits other than emergency care, urgent care, and continuity of …
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N.J. Rev. Stat. § 17B:27A-7.3. Health care quality requirements: Individual Health Insurance Reform – New Jersey
Status: Enacted Year Enacted: 1997
Notwithstanding the provisions of P.L.1992, c. 161 to the contrary, no policy shall be delivered, issued, executed or renewed on or after the effective date of this act unless the policy or contract meets the …
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N.J. Rev. Stat. § 26:2S-11. Health Care Appeals Program established: Health Care Quality Act – New Jersey
Status: Enacted Year Enacted: 1997
Establishes an appeals provider to review medical necessity or appropriateness of services .
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N.J. Rev. Stat. § 26:2S-6.1. Carriers offering both in-network and out-of-network benefits; certain reimbursements: Health Care Quality Act – New Jersey
Status: Enacted Year Enacted: 2001
States that in the event a covered person is admitted to an out of network or in network provider for medically necessary services or receives covered medically necessary covered services from an out of network …
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