NAC695C.170. Health maintenance organization: Required services; optional plans.

     1. The comprehensive health care services offered by a health maintenance organization in its evidence of coverage must provide for basic and preventive medical care for the enrollee which is medically necessary, including:

     (a) Services in an emergency provided by a hospital or physician;

     (b) Any care received as an admitted patient at a hospital;

     (c) Care by a physician; and

     (d) Medical services as an outpatient.

     2. The health maintenance organization, as a part of its comprehensive services, must offer to the subscriber optional plans for optometric, dental and pharmaceutical care. The subscriber may be subject to an additional charge for these types of care.

     (Added to NAC by Comm’r of Insurance, eff. 6-11-86; A by R148-99, 1-27-2000)