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 Jun. 15, 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

Accessed:
Jun. 15, 2024

Last modified:
Sep. 22, 2014

§ 4406-B’s source at nysenate​.gov

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