(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.
HISTORY: 1998 Act No. 329, Section 2.
Structure South Carolina Code of Laws
Chapter 33 - Health Maintenance Organizations
Section 38-33-10. Short title.
Section 38-33-20. Definitions.
Section 38-33-30. Necessity of certificate of authority; foreign corporation.
Section 38-33-50. Powers of health maintenance organization; notice prior to exercise of powers.
Section 38-33-60. Members of governing body; advisory panels, etc.
Section 38-33-70. Fiduciary relationship in handling of funds.
Section 38-33-90. Statements and reports.
Section 38-33-120. Investment of funds.
Section 38-33-150. Agent for organization; exemption from licensing requirements.
Section 38-33-180. Suspension or revocation of certificate of authority.
Section 38-33-200. Implementation of regulations.
Section 38-33-250. Records of organization as public documents; trade secrets, etc.
Section 38-33-260. Confidentiality of health records.
Section 38-33-300. Liability for participation in quality of care or utilization review.
Section 38-33-310. HMO may contract with out-of-state provider.