                                 CODE OF VIRGINIA

CHOICE OF A HEALTH CARE PROFESSIONAL (§ 38.2-3443)

A. Notwithstanding any provision of &#xA7; 38.2-3407.11, 38.2-4312.3, or any
other section of this title to the contrary, if a health carrier providing
individual or group health insurance coverage requires or provides for the
designation by a covered person of a participating primary care health care
professional, the health carrier shall permit each covered person to designate
any participating primary care health care professional who is available to
accept the covered person. For a child, a participating health care professional
who specializes in pediatrics and is available to accept the child may be
designated as the child&#8217;s primary care health care professional.

B. If a health carrier provides for obstetrical or gynecological care and
requires the designation by a covered person of a participating primary care
health care professional, the health carrier shall not require any
person&#8217;s prior authorization or referral in the case of a female covered
person who seeks coverage for obstetrical or gynecological care provided by a
participating health care professional who specializes in obstetrics or
gynecology. The provision of obstetrical and gynecological care, and the
ordering of related items and services, shall be treated the same as an
authorization from a primary care health care professional.

C. A health carrier shall provide notice to a covered person of the terms and
conditions of the plan related to the designation of a participating health care
professional.

   1. Such notice shall be included whenever the health carrier provides a
   covered person with a summary plan description, policy, certificate, or
   contract of health insurance.

   2. The health carrier may use the model language found in 45 C.F.R. &#xA7;
   147.138(a)(4)(iii) for such notice.

D. This section shall apply to any health carrier providing individual or group
health insurance coverage, except for any grandfathered plan.

HISTORY: 2011, c. 882.