Terms Used In Montana Code > Title 33 > Chapter 31 - Health Maintenance Organizations

• Accountable care organization: means a group of health care providers that are willing and capable of accepting accountability for the total cost and quality of care for a defined population. See Montana Code 33-31-102
• Affiliation period: means a period that, under the terms of the health insurance coverage offered by a health maintenance organization, must expire before the health insurance coverage becomes effective. See Montana Code 33-31-102
• Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
• Basic health care services: means :

  (a)consultative, diagnostic, therapeutic, and referral services by a provider;

  (b)inpatient hospital and provider care;

  (c)outpatient medical services;

  (d)medical treatment and referral services;

  (e)accident and sickness services by a provider to each newborn infant of an enrollee pursuant to 33-31-301(3)(e);

  (f)care and treatment of mental illness, alcoholism, and drug addiction;

  (g)diagnostic laboratory and diagnostic and therapeutic radiologic services;

  (h)preventive health services, including:

  (i)immunizations;

  (ii)well-child care from birth;

  (iii)periodic health evaluations for adults;

  (iv)voluntary family planning services;

  (v)infertility services; and

  (vi)children's eye and ear examinations conducted to determine the need for vision and hearing correction;

  (i)minimum mammography examination, as defined in 33-22-132;

  (j)outpatient self-management training and education for the treatment of diabetes along with certain diabetic equipment and supplies as provided in 33-22-129; and

  (k)treatment and medical foods for inborn errors of metabolism. See Montana Code 33-31-102

• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Commission: means the commission on courts of limited jurisdiction established by the supreme court. See Montana Code 3-1-1501
• Commissioner: means the commissioner of insurance of the state of Montana. See Montana Code 33-31-102
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Continuance: Putting off of a hearing ot trial until a later time.
• Contract: A legal written agreement that becomes binding when signed.
• Customary: means according to usage. See Montana Code 1-1-206
• Dependent: has the meaning provided in 33-22-140. See Montana Code 33-31-102
• Dependent: A person dependent for support upon another.
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• Enrollee: means a person:

  (a)who enrolls in or contracts with a health maintenance organization;

  (b)on whose behalf a contract is made with a health maintenance organization to receive health care services; or

  (c)on whose behalf the health maintenance organization contracts to receive health care services. See Montana Code 33-31-102

• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Evidence of coverage: means a certificate, agreement, policy, or contract issued to an enrollee setting forth the coverage to which the enrollee is entitled. See Montana Code 33-31-102
• Fiduciary: A trustee, executor, or administrator.
• Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. ^{Source: Federal Reserve}
• Health care services: means :

  (a)the services included in furnishing medical or dental care to a person;

  (b)the services included in hospitalizing a person;

  (c)the services incident to furnishing medical or dental care or hospitalization; or

  (d)the services included in furnishing to a person other services for the purpose of preventing, alleviating, curing, or healing illness, injury, or physical disability. See Montana Code 33-31-102

• Health care services agreement: means an agreement for health care services between a health maintenance organization and an enrollee. See Montana Code 33-31-102
• Health maintenance organization: means a person who provides or arranges for basic health care services to enrollees on a prepaid basis, either directly through provider employees or through contractual or other arrangements with a provider or a group of providers. See Montana Code 33-31-102
• Insurance producer: means an individual or business entity appointed or authorized by a health maintenance organization to solicit applications for health care services agreements on its behalf. See Montana Code 33-31-102
• Judge: means :

  (a)a municipal court judge;

  (b)a justice of the peace; or

  (c)a city judge. See Montana Code 3-1-1501

• Judicial officers: means justices of the supreme court, judges of the district courts, justices of the peace, municipal judges, and city judges. See Montana Code 1-1-202
• Knowingly: means only a knowledge that the facts exist which bring the act or omission within the provisions of this code. See Montana Code 1-1-204
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• Lien: A claim against real or personal property in satisfaction of a debt.
• Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
• Oath: A promise to tell the truth.
• Oath: includes an affirmation or declaration. See Montana Code 1-1-201
• PACE organization: means an organization, as defined in 42 C. See Montana Code 33-31-102
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Person: means :

  (a)an individual;

  (b)a group of individuals;

  (c)an insurer, as defined in 33-1-201;

  (d)a health service corporation, as defined in 33-30-101;

  (e)a corporation, partnership, facility, association, or trust; or

  (f)an institution of a governmental unit of any state licensed by that state to provide health care, including but not limited to a physician, hospital, hospital-related facility, or long-term care facility. See Montana Code 33-31-102

• Plan: means a health maintenance organization operated by an insurer or health service corporation as an integral part of the corporation and not as a subsidiary. See Montana Code 33-31-102
• Point-of-service option: means a delivery system that permits an enrollee of a health maintenance organization to receive health care services from a provider who is, under the terms of the enrollee's contract for health care services with the health maintenance organization, not on the provider panel of the health maintenance organization. See Montana Code 33-31-102
• Process: means a writ or summons issued in the course of judicial proceedings. See Montana Code 1-1-202
• Provider: means a physician, hospital, hospital-related facility, long-term care facility, dentist, osteopath, chiropractor, optometrist, podiatrist, psychologist, licensed social worker, registered pharmacist, or advanced practice registered nurse, as specifically listed in 37-8-202, or registered nurse first assistant as defined by the board of nursing under Title 37, chapter 8, who treats any illness or injury within the scope and limitations of the provider's practice or any other person who is licensed or otherwise authorized in this state to furnish health care services. See Montana Code 33-31-102
• Provider panel: means those providers with whom a health maintenance organization contracts to provide health care services to the health maintenance organization's enrollees. See Montana Code 33-31-102
• Purchaser: means the individual, employer, or other entity, but not the individual certificate holder in the case of group insurance, that enters into a health care services agreement. See Montana Code 33-31-102
• Statute: A law passed by a legislature.
• United States: includes the District of Columbia and the territories. See Montana Code 1-1-201
• Writing: includes printing. See Montana Code 1-1-203