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This is an obsolete version of the rule. Please click on the rule number to view the current version.

37.79.606    REIMBURSEMENT OF INSURERS

(1) In consideration for all services rendered by an insurer under a contract with the department, the insurer will receive a payment each month for each enrollee. This payment is the premium. Unless otherwise provided in this rule, the premium represents the total obligation of the department with respect to the costs of medical care and benefits provided to each enrollee under the contract. Payment of the premium is considered to be payment in full and the insurer may not bill the enrollee, parent or guardian, nor let its providers bill the enrollee, parent or guardian for any medical care provided beyond the cost-sharing provisions outlined in ARM 37.79.501.

(2) The insurer may retain any savings realized by the insurer from the expenditures for necessary health benefits by the enrolled population totaling less than the premium paid by the department.

History: Sec. 53-4-1009, MCA; IMP, Sec. 53-4-1003, MCA; NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04.

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