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Patient Protections

Summary

Beginning Sept. 23, 2010, members can select any participating available primary care provider (PCP) as their PCP, and parents can choose any participating pediatrician as their child's PCP. Members have direct access to participating obstetrics or gynecology (OB-GYN) providers.

There are no prior authorization requirements for emergency services in a true emergency, even if the emergency services are provided by an out-of-network provider. Payment for the emergency service will follow the plan rules for network emergency coverage.

This provision applies to all non-grandfathered fully insured and self-funded group health plans, as well as group and individual health insurance issuers.

 

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