Section 26-A3512. POINT OF SERVICE PLAN

 

3512.1If an employer, association, or other private group arrangement offers health benefit plan coverage to employees or individuals only through an HMO, the HMO with which the employer, association, or other private group arrangement is contracting for the coverage shall offer, or contract with another carrier to offer, a point-of-service option to the employer, association, or other private group arrangement in conjunction with the HMO as an additional benefit for an employee or individual, at the employee's or individual's option to accept or reject.

 

3512.2An employee or individual who accepts the point of service option may be required to pay a premium over the amount of the premium for the coverage offered by the HMO.

 

3512.3Different cost-sharing provisions may be imposed by the HMO based on whether service is provided by the HMO's provider panel or by an out-of-network provider panel.

 

3512.4This section only applies to renewal or new subscriber contracts issued after April 9, 1997.

 

3512.5This section does not apply to individual subscriber contracts issued to a person who is not part of a contracted group of subscribers.

 

source

Final Rulemaking published at 46 DCR 7291(September 17, 1999).