A. A network of preferred providers;

B. Provisions requiring a 2nd surgical opinion; and

C. A procedure for additional utilization review by the carrier or its designated utilization review entity.

This subsection may not be construed to prohibit a carrier from including in its policy additional managed care and cost control provisions that, subject to the approval of the superintendent, have the potential to control costs in a manner that does not result in inequitable treatment of enrollees.

4. Basic levels of care.__The plan must provide basic levels of care for enrollees, including, but not limited to, the following:

A. A minimum of 90 days of inpatient hospitalization coverage per policy year;

B. Prenatal, postnatal and well-baby care;

C. Professional services including inpatient medical care, surgery and anesthesia, maternity delivery and emergency care; and

D. Outpatient services including emergency care, ambulatory or day surgery, diagnostic services, radiation and chemotherapy.

5. Enrollee's responsibility for payment. The following applies to the level of deductible, coinsurance and out-of-pocket payment maximum established for basic care medical plans.

A. The plan must include a deductible not less than $1,000 nor greater than $5,000 per covered enrollee per policy year.

B. The plan must include a coinsurance amount not less than 20% nor greater than 40%, except that the plan may establish coinsurance at not less than 40% nor greater than 75% for emergency care provided by a hospital. The maximum coinsurance amount per covered enrollee per policy year is $3,000.

C. The maximum out-of-pocket level may not be greater than $8,000 per covered enrollee per policy year.