31.12.07.07

.07 Group Contract Optional Provisions.

A. An HMO may include in group contracts any of the optional provisions described in C and D of this regulation.

B. An HMO may not include in a group contract an optional provision dealing with the same subjects set forth in C and D of this regulation if the provision is drafted in a manner that is less favorable to the group contract holder, subscriber, or member than the corresponding optional provision set forth in C and D of this regulation.

C. Physical Examination.

(1) An HMO may include a provision in a group contract giving the HMO the right to examine the person of the member when and as often as it may reasonably require during the pendency of a claim under the contract.

(2) If the HMO includes the provision described in C(1) of this regulation, the provision shall indicate that any physical examination required by the HMO will be performed at the expense of the HMO.

D. Arbitration.

(1) An HMO may include a provision in a group contract giving the group contract holder or the member the option of entering binding arbitration to settle a dispute with the HMO.

(2) If the HMO includes the provision described in D(1) of this regulation, the provision may not require the group contract holder or the member to enter binding arbitration.