HAR §17-1720-6
HAR §17-1720-6. Covered services
Length: 235 wordsOfficial source
Cite as Haw. Code R. § 17-1720-6
(a)
The services
minimally required to be provided by each participating
health plan are described in section 17-1720-10 and
shall be known as the standard benefits package.
(b)
The standard benefits package is based on a
twelve-month benefit period.
Service limits are pro-
rated for any benefit period less than twelve-months.
If an enrollee changes health plans during a benefit
period, the remaining unused service limits will be
covered by the new health plan for the duration of the
benefit period.
(c)
Based on clinical eligibility and medical
necessity, a participating health plan may provide
services described in section 17-1720-14 to an
enrollee.
(d)
Based on level of care eligibility, the
enrollee shall be provided services described in
sections 17-1720-18 or 17-1720-22 by the health plan.
(e)
A health plan may, at the health plan's
option, or as otherwise required by the contract
between the health plan and the departmentL or the
state plan, provide medically necessary services which
exceed the requirements of the standard benefits
package.
[Eff
09/30/13; am and comp
NOV I 0 2016
(Auth:
HRS §346-14; 42 C.F.R. §§.430.25, 438.6,
4 4 0 . 21 0 )
( I mp :
HRS § 3 4 6 - 14 ; 4 2 C . F . R . § § 4 3 0 . 2 5 ,
438.6, 440.210)
1720-3
320 6
§17-1720-10
§§17-1720-7 to 17-1720-9
(Reserved) .
SUBCHAPTER 3
STANDARD BENEFITS PACKAGE