Title 33, Chapter 30, Section 24
( 33-30-24)
Health care insurers may issue health benefit plans which provide
for incentives for covered persons to use the health care services
of preferred providers. Such policies or subscriber certificates
shall contain at least the following provisions: (1) A provision that if a covered person receives emergency care
for services specified in the preferred provider arrangement and
cannot reasonably reach a preferred provider, that emergency care
rendered during the course of the emergency will be paid for in
accordance with the terms of the health benefit plan, at benefit
levels at least equal to those applicable to treatment by
preferred providers for emergency care in an amount based on the
usual, customary, and reasonable charges in the area where the
treatment is provided; and (2) A provision which clearly identifies the differences in
benefit levels for health care services of preferred providers and
benefit levels for health care services of nonpreferred providers. |