Current through Vol. 42, No. 8, January 2, 2025
Section 365:40-5-111 - Marketing and enrolling(a) All marketing, enrollment, or informational materials produced by the HMO shall specify the approved geographic service area within which contracting providers are reasonably available and accessible.(b) The Department recognizes that under some circumstances, persons who neither live nor work in the service area desire to enroll in an HMO. Those may include, but are not limited to, the following persons.(2) Persons living or working at or near the service area boundary, and whose neighbors are eligible for enrollment;(3) Employees who have been relocated;(4) Persons whose best or only health coverage option is an HMO, despite the additional travel time required;(5) Persons who customarily choose to travel to the service area for their health services; or(6) Family members living apart from one another, as a result of circumstances such as legal separation or divorce.(c) The HMO must ensure that each subscriber living and working outside the service area, upon enrolling, signs a form showing understanding that his or her residence falls outside the service area and agreeing to seek all services, except emergency services as defined in the HMO contract, within the approved service area.(d) Nothing in this section, or in the Department's approval of an HMO, shall be construed as authorization for the plan to enroll, solicit, or market to, any person who resides outside this state.Okla. Admin. Code § 365:40-5-111
Added at 21 Ok Reg 77, eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff 7-14-04