Utah Code 31A-8a-206. Provider agreements — Record keeping
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(1) A health discount program operator may not place any restrictions on an enrollee‘s access to health care providers such as waiting periods or notification periods.
Terms Used In Utah Code 31A-8a-206
- Administrator: means the same as that term is defined in Subsection (187). See Utah Code 31A-1-301
- Enrollee: includes an insured. See Utah Code 31A-1-301
- Health care: means any of the following intended for use in the diagnosis, treatment, mitigation, or prevention of a human ailment or impairment:(83)(a) a professional service;(83)(b) a personal service;(83)(c) a facility;(83)(d) equipment;(83)(e) a device;(83)(f) supplies; or(83)(g) medicine. See Utah Code 31A-1-301
- Health care provider: means a health care provider as defined in Section 78B-3-403, with the exception of "licensed athletic trainer" who:
(2)(a) is practicing within the scope of the provider's license; and(2)(b) has agreed either directly or indirectly, by contract or any other arrangement with a health discount program operator, to provide a discount to enrollees of a health discount program. See Utah Code 31A-8a-102- Health discount program: means a business arrangement or contract in which a person pays fees, dues, charges, or other consideration in exchange for a program that provides access to health care providers who agree to provide a discount for health care services. See Utah Code 31A-8a-102
- Health discount program operator: means a person that provides a health discount program by entering into a contract or agreement, directly or indirectly, with a person or persons in this state who agree to provide discounts for health care services to enrollees of the health discount program and determines the charge to members. See Utah Code 31A-8a-102
(2) A health discount program operator may not reimburse health care providers for services rendered to an enrollee, unless the health discount program operator is a licensed third party administrator.(3)(3)(a) A health discount program operator shall have a written agreement with a health care provider who agrees to provide discounts to health discount program enrollees.(3)(b) If the written agreement is with a provider network, the health discount plan shall require the provider network to have written agreements with each of its health care providers.(4) The health discount program operator shall maintain a copy of each active health care provider agreement. - Health care provider: means a health care provider as defined in Section 78B-3-403, with the exception of "licensed athletic trainer" who: