The laws explained
- Extension of dependent coverage
- Preventive care coverage
- Lifetime and annual limits
- Pre-existing condition exclusions
- Prohibition on rescission
- Coverage of emergency services
- Primary Care Provider selection
- Salary nondiscrimination in benefits
- Early Retiree Reinsurance Program (ERRP)
- Small business tax credit
- Tax-treatment of OTC drugs
- Grandfathered Health Plans
Primary care provider selection
Health plans requiring members to select a primary care provider (PCP) must allow participants to choose any participating provider who's contracted as a PCP - as long as the doctor is accepting new patients. Under the law, women can select OB/GYNs as their primary care provider and cannot be required to seek a referral or prior authorization to see an in-network OB/GYN specialist. Parents can select a pediatrician as their child's PCP.Required communication
If your plan requires employees to select a primary care physician or other health care provider (PCP), you must tell your employees that they can choose any participating provider. Women can choose an OB/GYN as their PCP and parents can choose a pediatrician for their children's PCP. In addition, women do not need to get a referral or authorization to seek care from an in-network OB/GYN specialist. This information must be included in a summary of plan benefits or other description of plan benefits.
See an example of copy you can use if your benefits summary does not include the communication.
Effective
The PCP selection requirement is in effect for non-grandfathered plans.
Our approach
Priority Health has always allowed women to select an OB/GYN specialist as their PCP and children to have a pediatrician as their PCP. Learn more.
