Section 26-A3514. OTHER REQUIREMENTS

 

3514.1An HMO shall provide its enrollees with a list of the names and locations of all of its participating providers no later than the time of enrollment or the time the group or individual contract and evidence of coverage are issued, whichever is later. An HMO shall also provide its enrollees with such a list upon reenrollment, if requested. If a primary care provider ceases to be affiliated with an HMO, the HMO shall provide notice of such cessation to its affected enrollees within thirty (30) days of its occurrence. Subject to the approval of the Commissioner, an HMO may provide its enrollees with a list of providers or provider groups for a segment of the service area. However, a list of all providers shall be made available to subscribers upon request.

 

3514.2Any list of participating providers shall contain a notice regarding the availability of the listed primary care providers. Such notice shall be in not less than twelve (12) point type and be placed in a prominent place on the list of providers. The notice shall contain the following or similar language:

 

Enrolling in [name of HMO] does not guarantee services by a particular provider on this list. If you wish to receive care from specific providers listed, you should contact those providers to be sure that they are accepting additional patients for [name of HMO].

 

3514.3An HMO may require copayments or deductibles of enrollees as a condition for the receipt of specific health care services. Copayments for basic health care services shall be shown in the group or individual contract and evidence of coverage as a specified dollar amount.

 

source

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