AS 21.86.060: Provision of services and coverage.

(a) A health maintenance organization may provide provider services directly, through provider employees, or may provide the services under arrangements with individual providers or one or more groups of providers.

(b) In addition to basic health care services, a health maintenance organization may provide, or arrange for, other health care services on a prepayment, fixed fee, or other financial basis.

(c) Health care services may be provided only by appropriately licensed health care providers.

(d) A health maintenance organization shall provide coverage for emergency services, as that term is defined in AS 21.07.250, that are necessary to screen and stabilize a covered person at the health maintenance organization provider employee or contracted provider level of cost sharing when the services are not provided by a health maintenance organization provider. The health maintenance organization may require the transfer of a hospitalized covered person upon stabilization.

(e) A health maintenance organization shall provide coverage at the health maintenance organization provider employee or contracted provider level of cost sharing upon referral from a health maintenance organization provider that states the covered person requires medically necessary services from a provider that is not a health maintenance organization provider. The health maintenance organization may deny the referral when an in-network provider is available to provide the medically necessary services.