1374.65. Point-of-service plan contracts shall:
(a) Provide incentives, including financial incentives, for enrollees to use in-network coverage or services.
(b) Only offer coverage or services obtained out-of-network if it also provides coverage or services on an in-network basis.
(c) Shall not consider the following to be out-of-network coverage or services:
(1) Health care services received from a provider not affiliated with the health care service plan when the plan arranges for the enrollee to receive services from that provider.
(2) Out-of-area emergency care provided in accordance with the procedures set by the health care service plan to be followed in securing these services.
(Added by Stats. 1993, Ch. 987, Sec. 3. Effective January 1, 1994.)