(3) A system for the delivery of health care services |
throughout the State. Covered health care services must |
be provided to plan enrollees by participating |
providers who are located within the State and who are |
chosen by plan enrollees. The plan must pay for health |
care services provided to a plan enrollee while the |
enrollee is temporarily outside the State. The maximum |
period of time a plan enrollee may be covered while out |
of state is 90 days per year. A plan enrollee may |
qualify to begin services out of state but, in order to |
receive continued treatment, may be required to receive |
treatment within the State. Reimbursement for services |
rendered out of state must be at rates set by the |
board. A participating provider may not charge plan |
enrollees or 3rd parties for covered health care |
services in excess of the amount reimbursed to that |
provider by the plan. A participating provider may not |
refuse to provide services to a plan enrollee on the |
basis of health status, medical condition, previous |
insurance status, race, color, creed, age, national |
origin, citizenship status, gender, sexual orientation, |
disability or marital status; |