(a) A health maintenance organization shall offer to every enrollee a point-of-service plan option that would allow a covered person to receive covered services from an out-of-network health care provider without obtaining a referral or prior authorization from the health maintenance organization. The point-of-service plan option may require that an enrollee pay a higher deductible or copayment and higher premium for the plan.
(b) A health maintenance organization shall provide each enrollee with an opportunity at the time of enrollment and during the annual open enrollment period to enroll in the point-of-service plan option. The health maintenance organization shall provide written notice of the point-of-service plan option to each enrollee and shall include in that notice a detailed explanation of the financial costs to be incurred by an enrollee who selects that option.
Section: Previous 21.86.030 21.86.040 21.86.045 21.86.050 21.86.060 21.86.070 21.86.075 21.86.078 21.86.080 21.86.087 21.86.090 21.86.100 21.86.110 21.86.120 21.86.130 NextLast modified: November 15, 2016