N.Y. Insurance Law Section 4306-B
Primary and preventive obstetric and gynecologic care

Mentioned in

Your Rights as a Health Insurance Consumer

NY State Dept. of Financial Services, August 16, 2023

“You have many rights and protections if you have health insurance coverage through an HMO or insurer…”
 
Bibliographic info

(a)

No corporation subject to the provisions of this article shall by contract, written policy or procedure limit a female subscriber’s direct access to primary and preventive obstetric and gynecologic services, including annual examinations, care resulting from such annual examinations, and treatment of acute gynecologic conditions, from a qualified provider of such services of her choice from within the plan or for any care related to a pregnancy, provided that:

(1)

such qualified provider discusses such services and treatment plan with the subscriber’s primary care practitioner in accordance with the requirements of the corporation; and

(2)

such qualified provider agrees to adhere to the corporation’s policies and procedures, including any applicable procedures regarding referrals and obtaining prior authorization for services other than obstetric and gynecologic services rendered by such qualified provider, and agrees to provide services pursuant to a treatment plan (if any) approved by the corporation.

(b)

A corporation shall treat the provision of obstetric and gynecologic care, and the ordering of related obstetric and gynecologic items and services, pursuant to the direct access described in subsection (a) of this section by a participating qualified provider of such services, as the authorization of the primary care provider.

(c)

It shall be the duty of the administrative officer or other person in charge of each corporation subject to the provisions of this article to advise each female subscriber, in writing, of the provisions of this section.

Source: Section 4306-B — Primary and preventive obstetric and gynecologic care, https://www.­nysenate.­gov/legislation/laws/ISC/4306-B (updated Sep. 22, 2014; accessed Dec. 21, 2024).

4301
Organization of corporation 4302
Permit and license to do business 4303
Benefits 4303‑A
Prescription synchronization 4304
Individual contracts 4305
Group contracts 4306
Required contract provisions 4306‑A
Health insurance coverage for full-time students on medical leaves of absence 4306‑B
Primary and preventive obstetric and gynecologic care 4306‑C
Grievance procedure and access to specialty care 4306‑D
Choice of health care provider 4306‑E
Prohibition on lifetime and annual limits 4306‑F
Maternal depression screenings 4306‑G
Telehealth delivery of services 4306‑H
Essential health benefits package and limit on cost-sharing 4306‑I
Coverage for medically fragile children 4307
Providers of services 4308
Supervision of superintendent 4309
Limitation on expenses 4310
Investments 4312
Employment of solicitors 4313
Applicability of other provisions of this chapter 4314
Not to affect provisions of workers’ compensation law 4315
Arbitration 4316
Individual contracts 4317
Rating of individual and small group health insurance contracts 4318
Pre-existing condition provisions 4318‑A
Certification of creditable coverage by corporations organized under this article 4320
Limitations on administrative services and stop-loss coverage 4321
Standardization of individual enrollee direct payment contracts offered by health maintenance organizations prior to October first, two t... 4321‑A
Fund for standardized individual enrollee direct payment contracts 4322
Standardization of individual enrollee direct payment contracts offered by health maintenance organizations which provide out-of-plan ben... 4322‑A
Fund for standardized individual enrollee direct payment contracts which provide out-of-plan benefits 4323
Marketing materials 4324
Disclosure of information 4325
Prohibitions 4326
Standardized health insurance contracts for qualifying small employers and individuals 4327
Stop loss funds for standardized health insurance contracts issued to qualifying small employers and qualifying individuals 4328
Individual enrollee direct payment contracts offered by health maintenance organization on and after October first, two thousand thirteen 4329
Prescription drug coverage 4330
Discrimination because of sex or marital status in hospital, surgical or medical expense insurance
Green check means up to date. Up to date

Accessed:
Dec. 21, 2024

Last modified:
Sep. 22, 2014

§ 4306-B’s source at nysenate​.gov

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