A Medicare select policy or certificate may not restrict payment for covered services provided by providers outside the network if:

1. (1) The services are for symptoms requiring emergency care or are immediately required for an unforeseen illness, injury, or a condition; and
2. (2) It is not appropriate given specific circumstances, such as time or distance, to obtain such services through a network provider.

Source: 22 SDR 107, effective February 18, 1996; 23 SDR 236, effective July 13, 1997.

General Authority: SDCL 58-17A-2(5) , 58-17A-2.

Law Implemented: SDCL 58-17A-2.