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Patient Protection Notice (Choice of Provider)

Explains the right to designate any participating PCP/pediatrician and access OB/GYN care without a referral. Required when the plan requires or allows PCP designation.

Companies Eligible

Non-grandfathered plans that require or allow designation of a primary care provider — HMO, POS and some EPO designs.

A PPO with no PCP designation does not need it; document that it does not apply.

What it is

The notice explains the right to designate any participating primary care provider (and a pediatrician for children) and to see an in-network OB/GYN without a referral.

What needs to be done

  • When: Whenever the plan provides an SPD or similar description of benefits — in the SPD and the annual packet.
  • To whom: Participants and beneficiaries.
  • Who performs: Employer; carriers include it in insured plan certificates.
  • Customize: Plan name and the carrier phone number or website for provider lists.
  • Deliver: With the SPD and the annual packet.
  • Keep: Packet contents by year.

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