(1) An insurer may impose the following requirements in the provision of benefits:

(a) the use of certain types of providers to the extent allowed by law;

(b) preauthorization for benefits other than emergency services;

(c) directing an enrollee to the appropriate level of care for receipt of covered benefits; and

(d) denial of payment to a provider for benefits provided to an enrollee if the participation requirements in this rule are not met by the enrollee or the enrollee’s parent or guardian.

(2) An enrollee must use an insurer's participating providers unless:

(a) the insurer authorizes a nonparticipating provider to provide a service; or

(b) the enrollee receives emergency services or emergency room screen.

(3) An insurer and its participating providers must provide covered benefits as listed in this subchapter to enrollees in the same manner as those benefits are provided to non-CHIP members in the insurance plan.

(4) An insurer may at its discretion offer benefits beyond the scope of CHIP benefits defined in this subchapter.