6.6.602    DEFINITIONS

For the purposes of ARM 6.6.601 through 6.6.614:

(1) "Complaint" means any dissatisfaction expressed by an individual concerning a medicare select issuer or its network providers.

(2) "Grievance" means dissatisfaction expressed in writing by an individual insured under a medicare select policy or certificate with the administration, claims practices, or provision of services concerning a medicare select issuer or its network providers.

(3) "Medicare select issuer" means an issuer offering, or seeking to offer, a medicare select policy or certificate.

(4) "Medicare select policy" or "medicare select certificate" mean respectively a medicare supplement policy or certificate that contains restricted network provisions.

(5) "Network provider" means a provider of health care, or a group of providers of health care, which has entered into a written agreement with the issuer to provide benefits insured under a medicare select policy.

(6) "Restricted network provision" means any provision which conditions the payment of benefits, in whole or in part, on the use of network providers.

(7) "Service area" means the geographic area approved by the commissioner within which an issuer is authorized to offer a medicare select policy.

History: 33-22-904 and 33-22-905, MCA; IMP, 33-22-901 through 33-22-924, MCA; NEW, 1996 MAR p. 907, Eff. 4/5/96.