With regard to
participating providers who are physicians who are members of the American College of Obstetrics and Gynecology, organizations operating under this chapter shall:
| (1) |
permit a female enrollee to receive at least one outpatient examination per year from the enrollee’s choice of one of those participating providers. An organization may not require the enrollee to receive a preapproval, preauthorization, or referral from the enrollee’s primary care physician before receiving this examination; and |
Terms Used In Utah Code 31A-8-105.5
- Enrollee: includes an insured. See Utah Code 31A-1-301
- Health benefit plan: means a policy, contract, certificate, or agreement offered or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care, including major medical expense coverage. See Utah Code 31A-1-301
- Participating: means a plan of insurance under which the insured is entitled to receive a dividend representing a share of the surplus of the insurer. See Utah Code 31A-1-301
- State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
| (2) |
clearly state in the organization’s health benefit plan literature that enrollees may seek the care described in Subsection (1) without preapproval, preauthorization, or referral from the patient’s primary care physician. |
Amended by Chapter 10, 1997 General Session
