Code of Massachusetts Regulations
940 CMR - OFFICE OF THE ATTORNEY GENERAL
Title 940 CMR 26.00 - Discount health plans and discount health plan organizations
Section 26.06 - Required Provider Agreements

Universal Citation: 940 MA Code of Regs 940.26

Current through Register 1518, March 29, 2024

(1) It is an unfair or deceptive act in violation of MGL c. 93A s. 2(a) for a discount health plan organization to solicit, arrange, or accept payment in connection with offering, arranging or providing a health discount plan unless the discount plan organization has a written provider agreement with all providers offering medical, pharmacy or ancillary services to its members. The written provider agreement may be entered into directly with the provider or with a provider network to which the provider belongs.

(2) For purposes of this section, a provider agreement between a discount health plan or a discount health plan organization and a provider network or a provider shall include the following:

(i) a list of all medical, ancillary or pharmacy services to be provided at a discount;

(ii) either the amount(s) of the discounts, expressed as a percentage or dollar amount or, alternatively, a fee schedule that reflects the provider's discounted rates; and

(iii) a provision that prohibits the provider from charging members more than the discounted rates.

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