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UNOFFICIAL 1720.1-3 SUBCHAPTER 2

FREEDOM OF CHOICE

§17-1720.1-7 Purpose. This subchapter describes the provisions regarding an eligible individual’s freedom of choice in the selection of a participating health plan and a primary care provider. [Eff 09/30/13] (Auth: HRS §346-14; 42 C.F.R. §§430.25, 431.51, 438.52) (Imp: HRS §346-14; 42 C.F.R. §§430.25, 431.51, 438.52)

§17-1720.1-8 Choice of health plans. (a) Except for the conditions in section 17-1720.1-13, an eligible individual shall be allowed to select from among the participating health plans, of which the individual is not subject to an enrollment limit, servicing the geographic area in which the individual resides. This provision shall not apply to an enrolled individual identified in subsection (c). (b) If a health plan has reached its maximum enrollment, the eligible individual shall select another participating health plan that is available. If only one other participating health plan is available, subsection (c) shall apply. (c) In the absence of a choice of health plans in a service area, an eligible individual shall be enrolled in the participating health plan accepting new members. [Eff 09/30/13] (Auth: HRS §346-14; 42 C.F.R. §§430.25, 438.52) (Imp: HRS §346-14; 42 C.F.R. §§430.25, 438.52)

§17-1720.1-9 Choice of primary care providers. (a) In accordance with the procedures established by the participating health plan, an eligible individual shall be allowed to select a primary care provider from among those available within the health plan’s provider network.