The health care reform law includes certain requirements, called patient protections, in relation to choice of providers. The requirements are similar to many state laws in effect today, and the rules apply to non-grandfathered plans that utilize a network of providers.
If the plan requires or provides for the designation of a primary care provider (PCP), the participant must be able to designate any participating PCP who is available to accept the patient. The plan may designate a PCP for a participant who enrolls without choosing a PCP.
For a child, the plan must allow a participating pediatrician to be designated as the PCP.
A plan cannot require pre-authorization or a referral to access an OB/GYN provider. If a participant visits a participating OB/GYN provider, the care received must be covered as though it were provided by the PCP.
For more information on health care reform and how it affects you, go to healthcare.gov or uhc.com/reform.
This communication is not intended as legal or tax advice. Please contact a competent legal or tax professional for personal advice on eligibility, tax treatment and restrictions. Federal and state laws and regulations are subject to change.