                                 CODE OF VIRGINIA

ACCESS TO OBSTETRICIAN-GYNECOLOGISTS (§ 38.2-3407.11)

A. Each (i) insurer proposing to issue individual or group accident and sickness
insurance policies providing hospital, medical and surgical or major medical
coverage on an expense incurred basis, (ii) corporation providing individual or
group accident and sickness subscription contracts, and (iii) health maintenance
organization providing a health care plan for health care services, whose
policies, contracts or plans, including any certificate or evidence of coverage
issued in connection with such policies, contracts or plans, include coverage
for obstetrical or gynecological services, shall permit any female of age 13 or
older covered thereunder direct access, as provided in subsection B, to the
health care services of a participating obstetrician-gynecologist (a) authorized
to provide services under such policy, contract or plan and (b) selected by such
female.

B. An annual examination, and routine health care services incident to and
rendered during an annual visit, may be performed without prior authorization
from the primary care physician. However, additional health care services may be
provided subject to the following:

   1. Consultation, which may be by telephone or electronically, with the primary
   care physician for follow-up care or subsequent visits;

   2. Prior consultation and authorization by the primary care physician before
   the patient may be directed to another specialty provider; and

   3. Prior authorization by the insurer, corporation, or health maintenance
   organization for proposed inpatient hospitalization or outpatient surgical
   procedures.

C. For the purpose of this section, &#8220;health care services&#8221; means the
full scope of medically necessary services provided by the
obstetrician-gynecologist in the care of or related to the female reproductive
system and breasts and in performing annual screening and immunization for
disorders and diseases in accordance with the most current published
recommendations of the American College of Obstetricians and Gynecologists. The
term includes services provided by advanced practice registered nurses and
physician assistants in collaboration with the obstetrician-gynecologists
providing care to individuals covered under any such policies, contracts or
plans.

D. Nothing contained herein shall prohibit an insurer, corporation, or health
maintenance organization from requiring a participating
obstetrician-gynecologist to provide written notification to the covered
female&#8217;s primary care physician of any visit to such
obstetrician-gynecologist. Such notification may include a description of the
health care services rendered at the time of the visit.

E. Each insurer, corporation or health maintenance organization subject to the
provisions of this section shall inform subscribers of the provisions of this
section. Such notice shall be provided in writing.

F. The requirements of this section shall apply to all insurance policies,
contracts, and plans delivered, issued for delivery, reissued, renewed, or
extended or at any time when any term of any such policy, contract, or plan is
changed or any premium adjustment is made. The provisions of this section shall
not apply to short-term travel or accident-only policies, or to short-term
nonrenewable policies of not more than six months&#8217; duration.

G. The provisions of this section shall not apply in any instance in which the
provisions of this section are inconsistent or in conflict with a provision of
Article 6 (&#xA7; 38.2-3438 et seq.) of Chapter 34.

HISTORY: 1996, c. 967; 1997, c. 806; 2001, c. 99; 2011, c. 882; 2023, c. 183.