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Health insurance rights & protections

Doctor choice & emergency room access

You have the right to choose the doctor you want from your health planโ€™s provider network. You also can use an out-of-network emergency room without penalty.
  • You pick your doctor: You can choose any available primary care provider in your insurance planโ€™s network. You can choose any available network pediatrician as your childโ€™s primary care doctor.
  • No referrals needed for OB-GYN services: You donโ€™t need to get a referral from a primary care provider before you can get obstetrical or gynecological (OB-GYN) care from a specialist.
  • Access to out-of-network emergency room services: Insurance plans canโ€™t require higher
    if you get emergency care from a hospital outside your plan's
    . They also canโ€™t require you to get prior approval before getting emergency room services from an out-of-network provider or hospital.

Does this apply to my plan?

Probably. These rights donโ€™t apply to health plans created or bought before March 23, 2010, which are known as grandfathered plans. Check your planโ€™s materials or ask your employer or benefits administrator to find out if your health plan is grandfathered.