405 IAC 10-7-10 Out-of-network services

Sec. 10. The following services shall be covered under the plan, even if provided out-of-network: (1) Family planning services. (2) Emergency services. (3) Medically necessary covered services if the member's managed care organization is unable to provide the services in network within: (A) thirty (30) miles of the member's residence for primary care; and (B) sixty (60) miles of the member's residence for specialty care. (4) Nurse practitioner services that are medically necessary covered services provided within the scope of the nurse practitioner's applicable license and certification. (5) Medically necessary covered services provided at a federally qualified health center or rural health clinic.