Under current law, a managed care plan (which is a health benefit plan that
requires or creates incentives for an enrollee to obtain health care services from
providers under contract with or employed by the health benefit plan) may require
an enrollee to designate a primary provider from among its participating providers,
to obtain health care services from the primary provider whenever reasonably
possible and to obtain a referral from the primary provider to another participating
provider before obtaining services from that other participating provider. However,
current law also requires a managed care plan to establish a procedure whereby an
enrollee may obtain a standing referral to obtain services from a participating
provider who is a specialist.

This bill provides that a managed care plan that covers obstetric or gynecologic
services must cover those services if obtained from a participating provider who is
a physician specializing in obstetrics and gynecology by a female enrollee without a
referral, even if that participating provider is not the female enrollee's primary
provider. In addition, the managed care plan may not require the female enrollee to
obtain a standing referral to the participating provider for the coverage. The bill
provides that a managed care plan may not penalize or restrict a female enrollee's
coverage on account of her having obtained the services without a referral and may

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not penalize or restrict the contract of a provider on account of his or her having
provided the services without a referral. A managed care plan must provide written
notice of the requirement in its policies and group certificates and, at open
enrollment time, to each female enrollee and each female applicant for coverage.