Virginia Administrative Code
Title 14 - INSURANCE
Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE
Chapter 211 - RULES GOVERNING HEALTH MAINTENANCE ORGANIZATIONS
Part IV - Services
Section 14VAC5-211-180 - Out-of-area services

In addition to out-of-area emergency services required to be provided as basic health care services, a health maintenance organization may offer indemnity benefits covering out-of-area services to its enrollees. A description of the procedure for obtaining out-of-area services and notification requirements before obtaining these services shall be included in the evidence of coverage as well as a description of restrictions or limitations on out-of-area services. Except for out-of-area emergency services, a health care plan that requires the enrollee to contact the health maintenance organization before obtaining out-of-area services shall provide for telephone consultation on a 24-hour per day, seven-day per week basis.

Statutory Authority: §§ 12.1-13 and 38.2-223 of the Code of Virginia.