§ 23-79-1205 - Coverage by participating providers -- Selection criteria and utilization protocols -- Maximum benefits -- Exclusions.
23-79-1205. Coverage by participating providers -- Selection criteria and utilization protocols -- Maximum benefits -- Exclusions.
(a) (1) This subchapter does not require and shall not be construed to require the coverage of services by providers who are not designated as covered providers or that are not selected as a participating provider by a group health benefit plan or insurer having a participating network of service providers.
(2) This subchapter does not expand the list or designation of participating providers as specified in any health benefit plan.
(b) Insurers or other issuers of any health benefit plan covered by this subchapter may continue to establish and apply selection criteria and utilization protocols for health care providers including:
(1) The designation of types of providers for which coverage is provided; and
(2) Credentialing criteria used in the selection of providers.
(c) A health care policy that provides coverage for the services offered under this subchapter may contain provisions for maximum benefits and coinsurance limitations, deductibles, exclusions, and utilization review protocols to the extent that the provisions are not inconsistent with the requirements of this subchapter.