29 U.S.C. § 1185k — Other patient protections

(a) Choice of health care professional. If a plan or issuer requires or allows a participant or beneficiary to designate an in-network primary care provider, it must allow each person to choose any available in-network primary care provider who will accept the person. (b) Access to pediatric care. (1) If a person’s child is covered and the plan or issuer requires or allows the child’s designation of an in-network primary care provider, it must allow the person to designate a physician specializing in pediatrics, allopathic or osteopathic, if that physician is in the plan or issuer’s network. (2) This does not waive any plan or coverage exclusion for pediatric care. (c) Patient access to obstetrical and gynecological care. (1)(A) A plan or issuer described in paragraph (2) may not require authorization or a referral from the plan, issuer, or any person, including the primary care provider, when a female participant or beneficiary seeks covered obstetrical or gynecological care from an in-network professional specializing in obstetrics or gynecology. The professional must otherwise follow the plan’s or issuer’s policies and procedures, including referral and prior-authorization procedures and any approved treatment plan. (B) The plan or issuer must treat that professional’s obstetrical or gynecological care and ordering of related items and services as the primary care provider’s authorization. (2) This applies to a plan or coverage that covers obstetric or gynecologic care and requires the person to designate an in-network primary care provider. (3) Paragraph (1) does not waive coverage exclusions for obstetrical or gynecological care or prevent the plan or issuer from requiring the obstetrical or gynecological provider to notify the primary care professional, plan, or issuer of treatment decisions.