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agency shall adopt rules establishing the premium to be paid | | by persons eligible under this paragraph and the method of | | payment. |
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| | | D.__To establish eligibility, each person must apply for a | | plan card, pay to the fund the premium determined applicable | | pursuant to section 374, subsection 1, paragraph B and | | satisfy the application requirements established by the | | agency. |
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| | | 3.__Health care benefits.__As provided in this subsection, the | | plan must provide coverage for health care services from | | participating providers within this State if those services are | | necessary or appropriate for the prevention, diagnosis or | | treatment of, or maintenance or rehabilitation following, injury, | | disability or disease.__The agency shall adopt rules regarding | | provision of the following covered health care services: |
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| | | B.__Medical and other professional services furnished by | | participating providers; |
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| | | C.__Laboratory tests and imaging procedures; |
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| | | D.__Home health care for persons requiring services | | performed by or under the supervision of professional or | | technical personnel, including, but not limited to, home | | care for acute illness, personal care attendant services and | | the medical component of home care for chronic illness.__ | | Notwithstanding any other provision of law, the plan may use | | copayments for permanent care services; |
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| | | E.__Rehabilitative services for persons receiving | | therapeutic care; |
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| | | F.__Prescription drugs and devices.__Unless the prescribing | | practitioner certifies that a more expensive drug is | | medically necessary, the plan may cover only part of the | | cost of a drug dispensed in a package or form of dosage or | | administration when the agency determines that a less | | expensive package or form of dosage or administration is | | available that is pharmaceutically equivalent in its | | therapeutic effect.__If a plan member chooses to purchase a | | more expensive drug under this paragraph, the plan member is | | responsible for paying the amount not covered by the plan; |
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| | | G.__Mental health services; |
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| | | H.__Substance abuse treatment; |
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