11 N.C. Admin. Code 12.1401

Current through Register Vol. 39, No. 13, January 2, 2025

Section 12 .1401 - APPLICABILITY AND SCOPE

This Section applies to any HMO that, under G.S. 58-67-35(a)(6)d, offers coverage to its enrollees for health care services that are received, other than in an emergency, from:

(1) Providers who are not employed by, under contract with, or otherwise affiliated with the HMO; or

(2) Providers who are employed by, under contract with, or otherwise affiliated with the HMO in instances when such services are not received in compliance with the HMO's health care plan requirements.

11 N.C. Admin. Code 12 .1401

Authority G.S. 58-2-40; 58-67-35; 58-67-150;
Eff. January 1, 1994;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.

Authority G.S. 58-2-40; 58-67-35; 58-67-150;
Eff. January 1, 1994.