1. (1) A medicare select policy or certificate must not restrict payment for covered services provided by non-network providers if:

   1. (a) the services are for symptoms requiring emergency care or are immediately required for an unforeseen illness, injury or a condition; and
   2. (b) it is not reasonable to obtain such services through a network provider.
2. (2) A medicare select policy or certificate must provide payment for full coverage under the policy for covered services that are not available through network providers.

Authorizing statute(s): 33-22-904 and 33-22-905, MCA

Implementing statute(s): 33-22-902, 33-22-903, 33-22-904, 33-22-921, 33-22-922, 33-22-923 and 33-22-924, MCA

History: NEW, 1996 MAR p. 907, Eff. 4/5/96; AMD, 2004 MAR p. 313, Eff. 2/13/04.