Requirements of health maintenance organizations

For purposes of this subchapter, the term “health maintenance organization” means a public or private entity which is organized under the laws of any State and which (1) provides basic and supplemental health services to its members in the manner prescribed by subsection (b), and (2) is organized and operated in the manner prescribed by subsection (c). A health maintenance organization shall provide, without limitations as to time or cost other than those prescribed by or under this subchapter, basic and supplemental health services to its members in the following manner: Except as provided in subparagraph (B), at least 90 percent of the services of a physician which are provided as basic health services shall be provided through— Subparagraph (A) does not apply to the provision of the services of a physician— Each health maintenance organization shall— have— adopt at least one of the following arrangements to protect its members from incurring liability for payment of any fees which are the legal obligation of such organization— An organization that offers health benefits coverage shall not be considered as failing to meet the requirements of this section notwithstanding that it provides, with respect to coverage offered in connection with a group health plan in the small or large group market (as defined in section 300gg–91(e) of this title), an affiliation period consistent with the provisions of section 2701(g).1