3 AAC 31.640 - Trade practices

(a) If the benefits under a membership agreement are in whole or in part contingent upon a medical necessity determination by the provider,

(1) medical necessity must be determined by a qualified medical professional; and

(2) what constitutes medical necessity must be clearly defined in the membership agreement.

(b) A provider shall comply with 3 AAC 26.605 - 3 AAC 26.749.

(c) A membership agreement must include

(1) a statement that the membership agreement is an insurance contract;

(2) the effective date of the agreement;

(3) a grace period of 30 days for payment of a renewal air ambulance service membership fee;

(4) a free-look period of 10 days during which a membership agreement may be returned by the member with a full refund of any air ambulance service membership fee; and

(5) if eligibility for a membership agreement is contingent upon the member's current and continuing insurance coverage, a description of what constitutes acceptable insurance coverage.

(d) A provider may not condition membership or continued membership on a person's health status.

(e) A membership agreement may not contain a provision asserting exclusive or discretionary authority to interpret the terms of the agreement.

(f) An air ambulance service membership fee or other consideration must be reasonable in relation to the benefits provided under a membership agreement and in aggregate must reasonably approximate the amounts that the members would expect to pay in the absence of the membership agreement over the period covered by the membership agreement.

Notes

3 AAC 31.640

Eff. 11/26/2015, Register 216, January 2016

Authority:AS 21.06.090

AS 21.42.120

AS 21.61.106

AS 21.61.109