§ 58-51-38. Direct access to obstetrician-gynecologists. - North Carolina Statutes

§58‑51‑38.  Direct access to obstetrician‑gynecologists.

(a)        Each health benefitplan shall allow each female plan participant or beneficiary age 13 or olderdirect access within the health benefit plan, without prior referral, to thehealth care services of an obstetrician‑gynecologist participating in thehealth benefit plan, within the benefits provided under that health benefitplan pertaining to obstetrician‑gynecologist services.

For purposes of this section:

(1)        "Health benefitplan" means an HMO subscriber contract or any preferred provider,exclusive provider, or other managed care arrangement offered under a healthbenefit plan, as defined in G.S. 58‑50‑110(11).

(2)        "Health careservices" means the full scope of medically necessary services provided bythe participating obstetrician‑gynecologist in the care of or related tothe female reproductive system and breasts, and in performing annual screening,counseling, and immunization for disorders and diseases in accordance with themost current published recommendations of the American College of Obstetriciansand Gynecologists, and includes services provided by nurse practitioners,physician's assistants, and certified nurse midwives in collaboration with theobstetrician‑gynecologist in the care of the participant or beneficiary.

(3)        "Benefits"are those medical services or other items to which an individual is entitledunder the terms of her contract with a health benefit plan, as approved by theDepartment of Insurance.

(b)        Each health benefitplan shall inform female participants and beneficiaries in writing of theprovisions of this section. The information shall be provided in benefithandbooks and materials and enrollment materials. (1995, c. 63, s. 1.)