62Q.52 DIRECT ACCESS TO OBSTETRIC AND GYNECOLOGIC SERVICES.
(a) Health plan companies shall allow female enrollees direct access to obstetricians and
gynecologists for the following services:
(1) annual preventive health examinations, which shall include a gynecologic examination,
and any subsequent obstetric or gynecologic visits determined to be medically necessary by the
examining obstetrician or gynecologist, based upon the findings of the examination;
(2) maternity care; and
(3) evaluation and necessary treatment for acute gynecologic conditions or emergencies.
(b) For purposes of this section, "direct access" means that a female enrollee may obtain the
obstetric and gynecologic services specified in paragraph (a) from obstetricians and gynecologists
in the enrollee's network without a referral from, or prior approval through, another physician, the
health plan company, or its representatives.
(c) Health plan companies shall not require higher co-payments, coinsurance, deductibles, or
other enrollee cost-sharing for direct access.
(d) This section applies only to services described in paragraph (a) that are covered by the
enrollee's coverage, but coverage of a preventive health examination for female enrollees must
not exclude coverage of a gynecologic examination.
History: 1997 c 26 s 1