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agency shall adopt rules establishing the premium to be paid | by persons eligible under this paragraph and the method of | payment. |
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| D.__To establish eligibility, each person must apply for a | plan card, pay to the fund the premium determined applicable | pursuant to section 374, subsection 1, paragraph B and | satisfy the application requirements established by the | agency. |
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| | 3.__Health care benefits.__As provided in this subsection, the | plan must provide coverage for health care services from | participating providers within this State if those services are | necessary or appropriate for the prevention, diagnosis or | treatment of, or maintenance or rehabilitation following, injury, | disability or disease.__The agency shall adopt rules regarding | provision of the following covered health care services: |
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| B.__Medical and other professional services furnished by | participating providers; |
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| C.__Laboratory tests and imaging procedures; |
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| D.__Home health care for persons requiring services | performed by or under the supervision of professional or | technical personnel, including, but not limited to, home | care for acute illness, personal care attendant services and | the medical component of home care for chronic illness.__ | Notwithstanding any other provision of law, the plan may use | copayments for permanent care services; |
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| E.__Rehabilitative services for persons receiving | therapeutic care; |
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| F.__Prescription drugs and devices.__Unless the prescribing | practitioner certifies that a more expensive drug is | medically necessary, the plan may cover only part of the | cost of a drug dispensed in a package or form of dosage or | administration when the agency determines that a less | expensive package or form of dosage or administration is | available that is pharmaceutically equivalent in its | therapeutic effect.__If a plan member chooses to purchase a | more expensive drug under this paragraph, the plan member is | responsible for paying the amount not covered by the plan; |
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| G.__Mental health services; |
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| H.__Substance abuse treatment; |
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