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(1) The following services, if medically necessary, are covered benefits:

(a) inpatient hospital;

(b) outpatient hospital;

(c) physician;

(d) advanced practice registered nursing;

(e) prescription drugs;

(f) laboratory and radiology;

(g) mental health;

(h) chemical dependency;

(i) vision;

(j) audiology; and

(k) medical dental benefits as provided in this subchapter unless specific limitations to benefit coverage are noted. A service may be subject to prior authorization requirements.

(2) Eyeglasses and dental benefits are paid by the department as specified in ARM 37.79.322 and 37.79.326.

(3) Emergency services, including urgent care and emergency room screening to determine if a medical emergency exists, shall be available 24 hours per day, seven days per week. In emergency situations, no prior authorization is required to provide necessary medical care and enrollees may seek care from nonparticipating providers. Prior authorization may be required for any needed follow-up care.

(4) Access to information through a 24-hour call-in service, commonly referred to as a "nurse advice line", is a covered benefit for HMK Plan members.

History: 53-4-1004, 53-4-1009, 53-4-1105, MCA; IMP, 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA; NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09.

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