['Employee Benefits']
['Health Plans']
12/05/2023
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(a) General rule. A PCIP may specify the networks of providers from whom enrollees may obtain plan services. The PCIP must demonstrate to HHS that it has a sufficient number and range of providers to ensure that all covered services are reasonably available and accessible to its enrollees.
(b) Emergency services. In the case of emergency services, such services must be covered out of network if:
(b)(1) The enrollee had a reasonable concern that failure to obtain immediate treatment could present a serious risk to his or her life or health; and
(b)(2) The services were required to assess whether a condition requiring immediate treatment exists, or to provide such immediate treatment where warranted.
[75 FR 45032 July 30, 2010]
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