Oregon Statutes - Chapter 743 - Health and Life Insurance - Section 743.845 - Designation of women’s health care provider as primary care provider; direct access to women’s health care provider.

(1) For purposes of this section:

(a) “Pregnancy care” means the care necessary to support a healthy pregnancy and care related to labor and delivery.

(b) “Women’s health care provider” means an obstetrician or gynecologist, physician assistant specializing in women’s health, advanced registered nurse practitioner specialist in women’s health or certified nurse midwife, practicing within the applicable lawful scope of practice.

(2) Every health insurance policy that covers hospital, medical or surgical expenses and requires an enrollee to designate a participating primary care provider shall permit a female enrollee to designate a women’s health care provider as the enrollee’s primary care provider if:

(a) The women’s health care provider meets the standards established by the insurer in collaboration with interested parties, including but not limited to the Oregon section of the American College of Obstetricians and Gynecologists; and

(b) The women’s health care provider requests that the insurer make the provider available for designation as a primary care provider.

(3) If a female enrollee has designated a primary care provider who is not a women’s health care provider, an insurance policy as described in subsection (2) of this section shall permit the enrollee to have direct access to a women’s health care provider for the following services:

(a) At least one annual preventative women’s health examination;

(b) Medically necessary follow-up visits resulting from a preventative women’s health examination. A health plan may require the women’s health care provider to notify and consult with the enrollee’s primary care provider; and

(c) Pregnancy care.

(4) The standards established by the insurer under subsection (2) of this section shall not prohibit an insurer from establishing the maximum number of participating primary care providers and participating women’s health care providers necessary to serve a defined population or geographic service area. [Formerly 743.813; 1999 c.607 §1; 2001 c.104 §291]

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Last modified: August 7, 2008