Ins 3.39(30t)(d)(d) A Medicare select issuer may not issue a Medicare select policy or certificate in this state until its plan of operation has been approved by the commissioner. Ins 3.39(30t)(e)(e) A Medicare select issuer shall file a proposed plan of operation with the commissioner in a format prescribed by the commissioner. The plan of operation shall contain at least all of the following information: Ins 3.39(30t)(e)1.1. Evidence that all covered services that are subject to restricted network provisions are available and accessible through network providers, including a demonstration of all of the following: Ins 3.39(30t)(e)1.a.a. That covered services can be provided by network providers with reasonable promptness with respect to geographic location, hours of operation and after-hour care. The hours of operation and availability of after-hour care shall reflect usual practice in the local area. Geographic availability shall reflect the usual medical travel times within the community. Ins 3.39(30t)(e)1.b.b. That the number of network providers in the service area is sufficient, with respect to current and expected policyholders or certificateholders, either to deliver adequately all services that are subject to a restricted network provision or to make appropriate referrals. Ins 3.39(30t)(e)1.c.c. That there are written agreements with network providers describing specific responsibilities. Ins 3.39(30t)(e)1.e.e. In the case of covered services that are subject to a restricted network provision and are provided on a prepaid basis, there are written agreements with network providers prohibiting such providers from billing or otherwise seeking reimbursement from or recourse against any individual insured under a Medicare select policy or certificate. This subd. 1. e. may not apply to supplemental charges, copayment, or coinsurance amounts as stated in the Medicare select policy or certificate. Ins 3.39(30t)(e)2.2. A statement or map providing a clear description of the service area. Ins 3.39(30t)(e)4.4. A description of the quality assurance program, including all of the following: Ins 3.39(30t)(e)4.b.b. The written criteria for selection, retention, and removal of network providers. Ins 3.39(30t)(e)6.6. Copies of the written information proposed to be used by the issuer to comply with par. (i). Ins 3.39(30t)(f)1.1. A Medicare select issuer shall file any proposed changes to the plan of operation, except for changes to the list of network providers, with the commissioner prior to implementing such changes. Such changes shall be considered approved by the commissioner after 30 days after filing unless specifically disapproved. Ins 3.39(30t)(f)2.2. An updated list of network providers shall be filed with the commissioner at least quarterly. Ins 3.39(30t)(g)(g) A Medicare select policy or certificate may not restrict payment for covered services provided by non-network providers if all of the following occur: Ins 3.39(30t)(g)1.1. The services are for symptoms requiring emergency care or are immediately required for an unforeseen illness, injury or a condition. Ins 3.39(30t)(g)2.2. It is not reasonable to obtain services described in subd. 1. through a network provider. Ins 3.39(30t)(h)(h) A Medicare select policy or certificate shall provide payment for full coverage under the policy or certificate for covered services that are not available through network providers. Ins 3.39(30t)(i)(i) A Medicare select issuer shall make full and fair disclosure in writing of the provisions, coinsurance, or copayments, restrictions, and limitations of the Medicare select policy or certificate to each applicant. This disclosure shall include at least the following: Ins 3.39(30t)(i)1.1. An outline of coverage in substantially the same format as Appendices 2t and 5t sufficient to permit the applicant to compare the coverage and premiums of the Medicare select policy or certificate to the following: