Required Provider Agreements

(1) It is an unfair or deceptive act in violation ofM.G.L. c. 93A, § 2(a) for a discount health plan organization to solicit, arrange, or accept payment in connection with offering, arranging or providing a health discount plan unless the discount plan organization has a written provider agreement with all providers offering medical, pharmacy or ancillary services to its members. The written provider agreement may be entered into directly with the provider or with a provider network to which the provider belongs. (2) For purposes of 940 CMR 26.06, a provider agreement between a discount health plan or a discount health plan organization and a provider network or a provider shall include the following: (a) a list of all medical, ancillary or pharmacy services to be provided at a discount; (b) either the amount(s) of the discounts, expressed as a percentage or dollar amount or, alternatively, a fee schedule that reflects the provider's discounted rates; and ( c) a provision that prohibits the provider from charging members more than the discounted rates. 940 CMR- 182