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Rule 20:06:13:68 Network restrictions.

          20:06:13:68.  Network restrictions. A Medicare select policy or certificate may not restrict payment for covered services provided by providers outside the network if:

          (1)  The services are for symptoms requiring emergency care or are immediately required for an unforeseen illness, injury, or a condition; and

          (2)  It is not appropriate given specific circumstances, such as time or distance, to obtain such services through a network provider.

          Source: 22 SDR 107, effective February 18, 1996; 23 SDR 236, effective July 13, 1997.

          General Authority: SDCL 58-17A-2(5), 58-17A-2.

          Law Implemented: SDCL 58-17A-2.


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