§ 38.2-3407.11. Access to obstetrician-gynecologists.
A. Each (i) insurer proposing to issue individual or group accident andsickness insurance policies providing hospital, medical and surgical or majormedical coverage on an expense incurred basis, (ii) corporation providingindividual or group accident and sickness subscription contracts, and (iii)health maintenance organization providing a health care plan for health careservices, whose policies, contracts or plans, including any certificate orevidence of coverage issued in connection with such policies, contracts orplans, include coverage for obstetrical or gynecological services, shallpermit any female of age thirteen or older covered thereunder direct access,as provided in subsection B, to the health care services of a participatingobstetrician-gynecologist (i) authorized to provide services under suchpolicy, contract or plan and (ii) selected by such female.
B. An annual examination, and routine health care services incident to andrendered during an annual visit, may be performed without prior authorizationfrom the primary care physician. However, additional health care services maybe provided subject to the following:
1. Consultation, which may be by telephone or electronically, with theprimary care physician for follow-up care or subsequent visits;
2. Prior consultation and authorization by the primary care physician beforethe patient may be directed to another specialty provider; and
3. Prior authorization by the insurer, corporation, or health maintenanceorganization for proposed inpatient hospitalization or outpatient surgicalprocedures.
C. For the purpose of this section, "health care services" means the fullscope of medically necessary services provided by theobstetrician-gynecologist in the care of or related to the femalereproductive system and breasts and in performing annual screening andimmunization for disorders and diseases in accordance with the most currentpublished recommendations of the American College of Obstetricians andGynecologists. The term includes services provided by nurse practitioners,physician assistants, and certified nurse midwives in collaboration with theobstetrician-gynecologists providing care to individuals covered under anysuch policies, contracts or plans.
D. Nothing contained herein shall prohibit an insurer, corporation, or healthmaintenance organization from requiring a participatingobstetrician-gynecologist to provide written notification to the coveredfemale's primary care physician of any visit to suchobstetrician-gynecologist. Such notification may include a description of thehealth care services rendered at the time of the visit.
E. Each insurer, corporation or health maintenance organization subject tothe provisions of this section shall inform subscribers of the provisions ofthis section. Such notice shall be provided in writing.
F. The requirements of this section shall apply to all insurance policies,contracts, and plans delivered, issued for delivery, reissued, renewed, orextended or at any time when any term of any such policy, contract, or planis changed or any premium adjustment is made. The provisions of this sectionshall not apply to short-term travel or accident-only policies, or toshort-term nonrenewable policies of not more than six months' duration.
§ 38.2-3407.11. Access to obstetrician-gynecologists.
A. Each (i) insurer proposing to issue individual or group accident andsickness insurance policies providing hospital, medical and surgical or majormedical coverage on an expense incurred basis, (ii) corporation providingindividual or group accident and sickness subscription contracts, and (iii)health maintenance organization providing a health care plan for health careservices, whose policies, contracts or plans, including any certificate orevidence of coverage issued in connection with such policies, contracts orplans, include coverage for obstetrical or gynecological services, shallpermit any female of age thirteen or older covered thereunder direct access,as provided in subsection B, to the health care services of a participatingobstetrician-gynecologist (i) authorized to provide services under suchpolicy, contract or plan and (ii) selected by such female.
B. An annual examination, and routine health care services incident to andrendered during an annual visit, may be performed without prior authorizationfrom the primary care physician. However, additional health care services maybe provided subject to the following:
1. Consultation, which may be by telephone or electronically, with theprimary care physician for follow-up care or subsequent visits;
2. Prior consultation and authorization by the primary care physician beforethe patient may be directed to another specialty provider; and
3. Prior authorization by the insurer, corporation, or health maintenanceorganization for proposed inpatient hospitalization or outpatient surgicalprocedures.
C. For the purpose of this section, "health care services" means the fullscope of medically necessary services provided by theobstetrician-gynecologist in the care of or related to the femalereproductive system and breasts and in performing annual screening andimmunization for disorders and diseases in accordance with the most currentpublished recommendations of the American College of Obstetricians andGynecologists. The term includes services provided by nurse practitioners,physician assistants, and certified nurse midwives in collaboration with theobstetrician-gynecologists providing care to individuals covered under anysuch policies, contracts or plans.
D. Nothing contained herein shall prohibit an insurer, corporation, or healthmaintenance organization from requiring a participatingobstetrician-gynecologist to provide written notification to the coveredfemale's primary care physician of any visit to suchobstetrician-gynecologist. Such notification may include a description of thehealth care services rendered at the time of the visit.
E. Each insurer, corporation or health maintenance organization subject tothe provisions of this section shall inform subscribers of the provisions ofthis section. Such notice shall be provided in writing.
F. The requirements of this section shall apply to all insurance policies,contracts, and plans delivered, issued for delivery, reissued, renewed, orextended or at any time when any term of any such policy, contract, or planis changed or any premium adjustment is made. The provisions of this sectionshall not apply to short-term travel or accident-only policies, or toshort-term nonrenewable policies of not more than six months' duration.
§ 38.2-3407.11. Access to obstetrician-gynecologists.
A. Each (i) insurer proposing to issue individual or group accident andsickness insurance policies providing hospital, medical and surgical or majormedical coverage on an expense incurred basis, (ii) corporation providingindividual or group accident and sickness subscription contracts, and (iii)health maintenance organization providing a health care plan for health careservices, whose policies, contracts or plans, including any certificate orevidence of coverage issued in connection with such policies, contracts orplans, include coverage for obstetrical or gynecological services, shallpermit any female of age thirteen or older covered thereunder direct access,as provided in subsection B, to the health care services of a participatingobstetrician-gynecologist (i) authorized to provide services under suchpolicy, contract or plan and (ii) selected by such female.
B. An annual examination, and routine health care services incident to andrendered during an annual visit, may be performed without prior authorizationfrom the primary care physician. However, additional health care services maybe provided subject to the following:
1. Consultation, which may be by telephone or electronically, with theprimary care physician for follow-up care or subsequent visits;
2. Prior consultation and authorization by the primary care physician beforethe patient may be directed to another specialty provider; and
3. Prior authorization by the insurer, corporation, or health maintenanceorganization for proposed inpatient hospitalization or outpatient surgicalprocedures.
C. For the purpose of this section, "health care services" means the fullscope of medically necessary services provided by theobstetrician-gynecologist in the care of or related to the femalereproductive system and breasts and in performing annual screening andimmunization for disorders and diseases in accordance with the most currentpublished recommendations of the American College of Obstetricians andGynecologists. The term includes services provided by nurse practitioners,physician assistants, and certified nurse midwives in collaboration with theobstetrician-gynecologists providing care to individuals covered under anysuch policies, contracts or plans.
D. Nothing contained herein shall prohibit an insurer, corporation, or healthmaintenance organization from requiring a participatingobstetrician-gynecologist to provide written notification to the coveredfemale's primary care physician of any visit to suchobstetrician-gynecologist. Such notification may include a description of thehealth care services rendered at the time of the visit.
E. Each insurer, corporation or health maintenance organization subject tothe provisions of this section shall inform subscribers of the provisions ofthis section. Such notice shall be provided in writing.
F. The requirements of this section shall apply to all insurance policies,contracts, and plans delivered, issued for delivery, reissued, renewed, orextended or at any time when any term of any such policy, contract, or planis changed or any premium adjustment is made. The provisions of this sectionshall not apply to short-term travel or accident-only policies, or toshort-term nonrenewable policies of not more than six months' duration.
