§ 38-33-325 — Obstetrician-gynecologist services; referrals; authorization for services; member notification of plan provisions.

South Carolina § 38-33-325

• Jurisdiction: South Carolina
• Title 38: INSURANCE
• Ch. 33: HEALTH MAINTENANCE ORGANIZATIONS

Text

(A) A health benefit plan shall allow a female enrollee thirteen years of age or older a minimum of two visits annually pursuant to the health benefit plan, without prior referral, to the health care services of an obstetrician-gynecologist in the health benefit plan. (B) For any continuing treatment resulting from obstetrical or gynecological, or both, complications diagnosed during the two visits for a calendar year, authorization must be made for medical necessity directly by the health maintenance organization. Written communication should be sent by the obstetrician-gynecologist to the patient's primary care physician regarding the condition being treated within a reasonable time after each visit. (C) A health benefit plan must notify its members of the provisions of this subsection (A). The information must be provided in the Summary Plan Description materials and enrollment materials. (D) For purposes of this section: (1) "Health benefit plan" means a health maintenance organization, a preferred provider plan, an exclusive provider plan, or other managed care arrangement plan; (2) "Health care services" means the full scope of medically necessary services provided by the participating obstetrician-gynecologist in the care of or related to the female reproductive system and breasts.

Legislative History

HISTORY: 1998 Act No. 329, SECTION 2.