§ 434.25 - Coverage and enrollment.  


Latest version.
  • (a) The contract must provide that—(1) There will be an open enrollment period doing which the HMO or PHP will accept individuals who are eligible to be covered under the contract—

    (i) In the order in which they apply;

    (ii) Without restriction, unless authorized by the Regional Administrator; and

    (iii) Up to the limits set under the contract; and

    (2) Enrollment is voluntary.

    (b) Risk comprehensive contracts with HMOs must also provide that the HMO will not discriminate, against individuals eligible to be covered under contract, on the basis of health status or need for health services.