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.
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