Health Care Reform

Provider Access

Health Care Reform includes a number of provider access requirements, and regulations impose notice requirements.  The following provider access rules apply to non-grandfathered plans for plan years beginning on or after September 23, 2010:

Choice of PCP

Non-grandfathered health plans can require participants to designate a primary care physician (PCP) or pediatrician, but participants of non-grandfathered plans must be permitted to designate any PCP or pediatrician participating in the plan's provider network.

Access to OB/GYN

Non-grandfathered health plans cannot require females to receive preauthorization for services from obstetricians or gynecologists.

Coverage of Emergency Services

Non-grandfathered health plans cannot require preauthorization for emergency services, limit coverage to only in-network providers, or impose higher cost-sharing for emergency services from an out-of-network provider.

Note: The provider access requirements only apply to certain types of health plans, such as major medical insurance.  They do not apply to HIPAA excepted benefits, such as disability, cancer,  hospital indemnity, or accident  insurance. Click here for more information about the types of benefits that are exempt from the Health Care Reform plan design mandates.

American Fidelity Assurance Company does not provide tax or legal advice.

ESB-832(0713)

Next Steps

Sign up for Updates

VIP Notification Service

We provide a VIP Notification Service to keep you informed as new Health Care Reform rules are issued.
Click here to sign up.

You’re Not Alone

We understand that these new requirements come at a time of strained budgets. 
Learn how our services and products can help.

Health Care Reform Timeline

What’s Due – And When? A simple timeline breaks down the new rules for you! Learn More

Time Line

Quick Access

  • Your Account

    View your policies, download forms and check the status of your claims - all in one spot!

  • Claim & Flex Forms

    1Select the forms you need:

    Flex Benefits
    Accident Benefits
    Cancer Benefits
    Critical Illness
    Disability Benefits
    Hospital Indemnity
    Life Benefits
    Medical (GAP)
    HRA Benefits

    2Select your state & industry:

  • Check Claim Status
  • FAQs

    Please select a category or type your question in the box below.

    Keyword Search
    All FAQs