"Out-of-plan covered services"

Sec. 23. (a) "Out-of-plan covered services" means nonemergency, self-referred covered health care services that: (1) are obtained from a provider who is: (A) not otherwise employed by; (B) not under contract with; and (C) not otherwise affiliated with; the health maintenance organization; or (2) are obtained from a participating provider without a referral. (b) The term does not include uncovered services. As added by P.L.26-1994, SEC.25.