Current through Register Vol. 54, No. 37, September 14, 2024
Section 9.652 - HMO provision of other than basic health services to enrolleesAn HMO may provide coverage for other than basic health services including dental services, vision care services, prescription drug services, durable medical equipment or other health care services, provided:
(1) The HMO establishes, maintains and operates a network of participating health care providers sufficient to provide reasonable access to and availability of the contracted nonbasic health services to enrollees in accordance with § 9.679 (relating to access requirements in service areas).(2) The health care provider contracts it uses to contract with participating providers meet the requirements of § 9.722 (relating to plan and health care provider contracts).(3) The provision of those health services is subject to the same complaint and grievance procedures applicable to the provision of basic health services.