2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 38. Medical Care and Pharmacy Discount Cards › Part 1. General Provisions › 33-38-102. Definitions

33-38-102. Definitions.
As used in this part, unless the context indicates otherwise, the following definitions apply:
(1) (a) "Administrator" has the meaning provided for in 33-17-102(3).
(b) The term includes a pharmacy benefit manager as defined in 33-2-2402.
(2) "Enroller" means a person who:
(a) solicits the purchase or renewal of a medical care discount card through that person;
(b) transmits, for consideration, from a supplier to another person or from another person to a supplier a contract or application for a medical care discount card or the renewal of a medical care discount card; or
(c) acts or aids in another manner in the delivery or negotiation of a medical care discount card or the renewal or continuance of a medical care discount card.
(3) "Health care provider" means:
(a) an individual licensed by the department of labor and industry to practice or who holds a temporary permit to practice a branch of the healing arts;
(b) a professional corporation organized pursuant to Title 35, chapter 4, by one or more individuals described in subsection (3)(a);
(c) a Montana limited liability company organized pursuant to Title 35, chapter 8, for the purpose of rendering professional services by individuals described in subsection (3)(a);
(d) a partnership of individuals described in subsection (3)(a);
(e) a Montana nonprofit corporation organized pursuant to Title 35, chapter 2, for the purpose of rendering professional health care services by one or more individuals described in subsection (3)(a); or
(f) a health care facility as defined in 50-5-101.
(4) "Health insurance issuer" means a health insurance issuer, as defined in 33-22-140, that is authorized to do business in this state and its affiliates, as defined in 33-2-1101.
(5) (a) "Medical care discount card" means a paper or plastic device or other mechanism, arrangement, account, or other device that does not constitute insurance, as defined in 33-1-201, that purports to grant, for consideration, a discount or access to a discount in a medical care-related purchase from a health care provider.
(b) The term does not include a pharmacy discount card unless a pharmacy discount benefit is combined with another type of medical care discount.
(6) "Medical care discount card supplier" means a person engaged in selling or furnishing, either as principal or agent, for consideration, one or more medical care discount cards to another person or persons.
(7) "Network of health care providers" means two or more health care providers who are contractually obligated to provide services in accordance with the terms and conditions applicable to a medical care discount card.
(8) "Pharmacy discount card" means a paper or plastic device or other mechanism, arrangement, account, or other device that does not constitute insurance, as defined in 33-1-201, that purports to grant, for consideration, a discount or access to a discount on one or more prescription drugs, and that is not combined with another type of medical care discount.
(9) "Pharmacy discount card supplier" means a person engaged in selling or furnishing, either as a principal or agent, for consideration, one or more pharmacy discount cards to another person or persons.
(10) "Preferred provider organization company" means a company that contracts with health care providers for lower fees than those customarily charged by the health care provider for services and contracts with health insurance issuers, administrators, or self-insured employers to provide access to those lower fees to a particular group of insureds, subscribers, participants, beneficiaries, members, or claimants.
(11) "Prescription drug provider" means a pharmacy or other business that is contractually bound to provide a discount on one or more prescription drugs in conjunction with the use of a pharmacy discount card.
(12) "Service area" means the area within a 60-mile radius of the home or place of business of a medical care discount card user or pharmacy discount card user.
History: En. Sec. 5, Ch. 456, L. 2005; amd. Sec. 20, Ch. 501, L. 2021.