N.Y. Public Health Law Section 4406-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

1.

The health maintenance organization shall not limit a female enrollee’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:

(a)

such qualified provider discusses such services and treatment plan with the enrollee’s primary care practitioner in accordance with the requirements of the health maintenance organization; and

(b)

such qualified provider agrees to adhere to the health maintenance organization’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 health maintenance organization.

2.

A health maintenance organization 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 subdivision one of this section by a participating qualified provider of such services, as the authorization of the primary care provider.

3.

It shall be the duty of the administrative officer or other person in charge of each health maintenance organization to advise each female enrollee, in writing, of the provisions of this section.

Source: Section 4406-B — Primary and preventive obstetric and gynecologic care, https://www.­nysenate.­gov/legislation/laws/PBH/4406-B (updated Sep. 22, 2014; accessed Dec. 21, 2024).

4400
Statement of policy and purposes 4401
Definitions 4402
Health maintenance organizations 4403
Health maintenance organizations 4403‑A
Special purpose certificate of authority 4403‑B
Development of comprehensive health services plans 4403‑C
Comprehensive HIV special needs plan certification 4403‑D
Special needs managed care plans 4403‑E
Primary care partial capitation providers 4403‑F
Managed long term care plans 4403‑G
Developmental disability individual support and care coordination organizations 4404
Health maintenance organizations 4405
Health maintenance organizations 4405‑A
Immunizations against poliomyelitis, mumps, measles, diphtheria and rubella 4405‑B
Duty to report 4406
Health maintenance organizations 4406‑A
Arbitration provisions of health maintenance organization contracts 4406‑B
Primary and preventive obstetric and gynecologic care 4406‑C
Prohibitions 4406‑D
Health care professional applications and terminations 4406‑E
Access to end of life care 4406‑F
Maternal depression screenings 4406‑G
Telehealth delivery of services 4406‑H
Health care facility applications 4406‑I
Utilization review determinations for medically fragile children 4407
Health maintenance organizations 4408
Disclosure of information 4408‑A
Integrated delivery systems 4408‑A*2
Grievance procedure 4409
Health maintenance organizations 4410
Health maintenance organizations 4411
Construction 4412
Separability 4413
Savings clause 4414
Health care compliance programs 4416
Excess reserves of certain health maintenance organizations
Green check means up to date. Up to date

Accessed:
Dec. 21, 2024

Last modified:
Sep. 22, 2014

§ 4406-B’s source at nysenate​.gov

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