2013 North Dakota Century Code
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DISCOUNT MEDICAL PLANS
As used in this chapter, unless the context otherwise requires:
1. "Discount medical plan" means any card, program, device, or mechanism that is not
insurance which purports to offer discounts or access to discounts from a provider
without recourse to the discount medical plan.
2. "Discount medical plan organization" means a person that, in exchange for fees, dues,
charges, or other consideration, provides access for plan members to a discount
3. "Marketer" means a person that markets, promotes, sells, or distributes a discount
4. "Medical services" means any care, service, or treatment of illness or dysfunction of,
or injury to, the human body, including physician care, inpatient care, hospital surgical
services, emergency services, ambulance services, dental care services, vision care
services, mental health services, substance abuse services, chiropractic services,
podiatric care services, and laboratory services. The term does not include
pharmaceutical supplies or prescriptions.
5. "Member" means any person that pays fees, dues, charges, or other consideration for
the right to receive the benefits of a discount medical plan.
6. "Provider" means any person that is contracted, directly or indirectly, with a discount
medical plan organization to provide medical services to members.
7. "Provider network" means a person that negotiates on behalf of more than one
provider with a discount medical plan organization to provide medical services to
26.1-53-02. Prohibited activities of a discount medical plan organization or marketer.
A discount medical plan organization may not:
1. Use in its advertisements, marketing material, brochures, and discount cards the term
"insurance" except as otherwise provided under this chapter.
2. Use in its advertisements, marketing material, brochures, and discount cards the terms
"health plan", "coverage", "copay", "copayments", "preexisting conditions",
"guaranteed issue", "premium", "PPO", "preferred provider organization", or other
terms in a manner that could reasonably mislead a person into believing the discount
medical plan is insurance.
3. Pay providers any fees for medical services, unless the organization is an authorized
1. A discount medical plan organization or marketer shall disclose clearly and
conspicuously in writing to any prospective member and on any advertisements,
marketing materials, or brochures relating to a discount medical plan:
a. That the plan is not an insurance policy.
b. That the plan provides discounts at certain health care providers for medical
c. That the plan member is obligated to pay for all health care services but will
receive a discount from those health care providers that have contracted with the
discount medical plan organization.
d. The name, address, and telephone number of the discount medical plan
organization and the marketer.
e. The cancellation and refund rights provided under section 26.1-53-08.
2. Any advertisements, marketing materials, or brochures relating to a discount medical
plan which are transmitted to the public through the internet or television must state
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that the plan is not an insurance policy and that the plan provides discounts at certain
health care providers for medical services.
The discount medical plan organization or marketer in solicitations conducted through
telemarketing shall disclose orally to prospective members the required disclosures
provided under subsection 1.
26.1-53-04. Provider agreements.
1. All providers offering medical services to members under a discount medical plan shall
provide such services pursuant to a written agreement with the discount medical plan
organization. The agreement may be entered directly by the provider or by a provider
network to which the provider belongs.
2. A provider agreement must provide the following:
a. A list of the services and products to be provided at a discount.
b. The amount or amounts of the discounts or, alternatively, a fee schedule that
reflects the provider's discounted rates.
c. That the provider will not charge members more than the discounted rates.
3. A provider agreement between a discount medical plan organization and a provider
network must require that the provider network have written agreements with the
provider network's providers which:
a. Comply with subsection 2.
b. Authorize the provider network to contract with the discount medical plan
organization on behalf of the provider.
c. Require the provider network to maintain an up-to-date list of the provider
network's contracted providers and to provide that list on a quarterly basis to the
discount medical plan organization.
4. The discount medical plan organization shall maintain a copy of each active provider
agreement and provide copies of the agreements to the commissioner, upon written
26.1-53-05. Provider name listing.
Each discount medical plan organization shall maintain an up-to-date list of the names and
addresses of the providers with which the discount medical plan organization has contracted,
and the discounts provided by those providers, on a website on the internet, the address of
which must be prominently displayed on all the discount medical plan organization
advertisements, marketing materials, brochures, and discount cards. This section applies to
those providers with which the discount medical plan organization has contracted directly, as
well as those that are members of a provider network with which the discount medical plan
organization has contracted.
26.1-53-06. Marketing of discount medical plans.
1. All advertisements, marketing materials, brochures, and discount cards used by
marketers must be approved in writing for such use by the discount medical plan
2. The discount medical plan organization must have an executed written agreement with
a marketer before the marketer's marketing, promoting, selling, or distributing the
discount medical plan.
26.1-53-07. Bundling discount medical plans with insurance products prohibited.
If a marketer or discount medical plan organization solicits, markets, or sells a discount
medical plan together with any insurance product, the marketer or organization shall disclose
clearly and conspicuously that the plan is not insurance.
26.1-53-08. Cancellation and refunds.
1. A discount medical plan shall permit members to cancel at any time. If cancellation
occurs within thirty days of the member receiving written notice of cancellation rights,
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the discount medical plan shall provide within thirty days of notice of cancellation a full
refund to the canceling member, except for a nominal fee associated with the
enrollment cost up to a maximum of fifty dollars. In the event of cancellation of the
membership by either party, if a discount medical plan charges for a time period in
excess of one month, the plan shall make a pro rata refund to the member.
The discount medical plan organization or marketer shall provide the member with
written notice of cancellation rights within ten business days of purchase. The notice of
cancellation rights must be clearly and conspicuously disclosed and must include
instructions for the member to cancel the plan. The instructions must be made
available to the commissioner upon request.
Cancellation occurs when notice of cancellation is given to the discount medical plan
organization or marketer.
Notice of cancellation is deemed given when delivered in hand, deposited in a
mailbox, properly addressed and postage prepaid, or e-mailed to the e-mail address of
the discount medical plan organization or marketer.
26.1-53-09. Enforcement - Powers - Remedies - Penalties.
The commissioner or the attorney general may enforce this chapter. The attorney general,
in enforcing this chapter, has all the powers provided in this chapter or chapter 51-15 and may
seek all remedies in this chapter or chapter 51-15. A violation of this chapter is deemed a
violation of chapter 51-15. The remedies, duties, prohibitions, and penalties of this chapter are
not exclusive and are in addition to all other causes of action, remedies, and penalties under
chapter 51-15, or otherwise provided by law.
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Title 26.1 Insurance
Chapter 26.1-53 Discount Medical Plans
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