LD 1241
pg. 11
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LR 1344
Item 1

 
D.__The plan must cover cash benefits paid to a
participating provider or to a plan member for a reasonable
amount charged for medically necessary emergency health care
services obtained by a plan member from a provider who is
not a participating provider.

 
§9805.__Eligibility; enrollment

 
Subject to the provisions of this section, all persons are
eligible to receive the benefits specified in section 9804.__The
board shall adopt rules regarding application for a plan card and
membership in the plan.__The rules must provide for at least the
following.

 
1.__Residency requirement.__A person not already covered under
a federally sponsored health plan who is a resident of this State
for at least one month at the time of enrollment is eligible to
receive health care under the plan and may enroll in the plan.__A
dependent member of an eligible person's household is also
eligible.

 
2.__Nonresidents.__A person who is not a resident of the State
who maintains significant contact with the State, including
employment or self-employment within the State or attendance at a
college, university or other institution of higher education in
the State, is eligible to receive health care under the plan.__
Eligibility extends to a person qualifying under this subsection
and to that person's spouse and dependents.__The board shall
adopt rules establishing criteria for eligibility for
nonresidents and determine the premium to be paid and the method
of payment.

 
3.__Continued participation.__A plan member who ceases to be
eligible for the plan may elect, within 60 days of__losing
eligibility, to continue participation in the plan for up to 18
months.__The board shall ensure that plan members who become
ineligible for enrollment in the plan are promptly notified of
the provisions of this subsection.__The board shall adopt rules
establishing the premium to be paid by persons eligible under
this subsection and the method of payment.

 
4.__Plan card.__To establish eligibility, each person must
apply for a plan card and satisfy the application requirements
established by the board.__The board shall ensure that the
applicant is issued a plan card within 30 days of receipt of a
completed application or provided a written explanation for
denial of the card or any restrictions placed on the applicant's
participation.__If good cause exists to believe that the
applicant does not meet the eligibility requirements in this


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