1. (a) "Out-of-plan covered services" means nonemergency, self-referred covered health care services that:

   1. (1) are obtained from a provider who is:

      1. (A) not otherwise employed by;
      2. (B) not under contract with; and

      3. (C) not otherwise affiliated with;

         the health maintenance organization; or

   2. (2) are obtained from a participating provider without a referral.
2. (b) The term does not include uncovered services.

As added by P.L.26-1994, SEC.25.