A network plan must disclose in writing, using the plain and ordinary meaning of words so as reasonably to ensure comprehension by the insured or member, and make available to an insured or a member at the time of enrollment:
(1) services or benefits under the plan, including limitations on services;
(2) rules regarding copayments, prior authorization, and review requirements that apply to the benefits plan of the insured or member;
(3) potential financial liability for the insured or member to pay for a portion of services received from an out-of-network provider;
(4) financial obligations of the insured or member for items and services both in and out of the network;
(5) the number, mix, and distribution of network providers and a current list of network providers upon request from an insured or a member;
(6) the rights and responsibilities of an insured or a member, including an explanation of any appeals process for the denial of care or services under the plan;
(7) the existence of any limitations on the choice of providers by an insured or a member.
HISTORY: 1998 Act No. 441, Section 1.
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