SECTION .1400 ‑ HMO: POINT‑OF‑SERVICE

11 NCAC 12 .1401             APPLICABILITY AND SCOPE

This Section applies to any HMO that, under G.S. 58‑67‑35(a)(6)d, offers coverage to its enrollees for health care services that are received, other than in an emergency, from:

(1)           Providers who are not employed by, under contract with, or otherwise affiliated with the HMO; or

(2)           Providers who are employed by, under contract with, or otherwise affiliated with the HMO in instances when such services are not received in compliance with the HMO's health care plan requirements.

History Note:        Authority G.S. 58‑2‑40; 58‑67‑35; 58‑67‑150;

Eff. January 1, 1994;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.