---
kind: "section"
citation: "29 U.S.C. § 1185k"
title: "29"
title_heading: "Labor"
number: "1185k"
heading: "Other patient protections"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/29/1185k"
units:
  - "Chapter 18 — Employee Retirement Income Security Program"
  - "Subchapter I — Protection of Employee Benefit Rights"
  - "Subtitle B — Regulatory Provisions"
  - "Part 7 — group health plan requirements"
  - "Subpart B — Other Requirements"
---

# §1185k. Other patient protections

- (a) **Choice of health care professional—** If a [group health plan](/usc/29/1167.md?p=1), or a [health insurance issuer](/usc/29/1191b.md?p=b-2) offering [group health insurance coverage](/usc/29/1191b.md?p=b-4), requires or provides for designation by a participant or beneficiary of a participating primary care provider, then the plan or issuer shall permit each participant and beneficiary to designate any participating primary care provider who is available to accept such [individual](/usc/29/1301.md?p=a-14-C-ii-V).
- (b) **Access to pediatric care—**
  - (1) **Pediatric care—** In the case of a [person](/usc/29/1301.md?p=a-20) who has a child who is a participant or beneficiary under a [group health plan](/usc/29/1167.md?p=1), or [group health insurance coverage](/usc/29/1191b.md?p=b-4) offered by a [health insurance issuer](/usc/29/1191b.md?p=b-2), if the plan or issuer requires or provides for the designation of a participating primary care provider for the child, the plan or issuer shall permit such [person](/usc/29/1301.md?p=a-20) to designate a physician (allopathic or osteopathic) who specializes in pediatrics as the child’s primary care provider if such provider participates in the network of the plan or issuer.
  - (2) **Construction—** Nothing in [paragraph (1)](#b-1) shall be construed to waive any exclusions of coverage under the terms and conditions of the plan or [health insurance coverage](/usc/29/1191b.md?p=b-1) with respect to coverage of pediatric care.
- (c) **Patient access to obstetrical and gynecological care—**
  - (1) **General rights—**
    - (A) **Direct access—** A [group health plan](/usc/29/1167.md?p=1), or [health insurance issuer](/usc/29/1191b.md?p=b-2) offering [group health insurance coverage](/usc/29/1191b.md?p=b-4), described in [paragraph (2)](#c-2) may not require authorization or referral by the plan, issuer, or any [person](/usc/29/1301.md?p=a-20) (including a primary care provider described in [paragraph (2)(B)](#c-2-B)) in the case of a female participant or beneficiary who seeks coverage for obstetrical or gynecological care provided by a participating health care professional who specializes in obstetrics or gynecology. Such professional shall agree to otherwise adhere to such plan’s or issuer’s policies and procedures, including procedures regarding referrals and obtaining prior authorization and providing services pursuant to a treatment plan (if any) approved by the plan or issuer.
    - (B) **Obstetrical and gynecological care—** A [group health plan](/usc/29/1167.md?p=1) or [health insurance issuer](/usc/29/1191b.md?p=b-2) described in [paragraph (2)](#c-2) shall treat the provision of obstetrical and gynecological care, and the ordering of related obstetrical and gynecological items and services, pursuant to the direct access described under [subparagraph (A)](#c-1-A), by a participating health care professional who specializes in obstetrics or gynecology as the authorization of the primary care provider.
  - (2) **Application of paragraph—** A [group health plan](/usc/29/1167.md?p=1), or [health insurance issuer](/usc/29/1191b.md?p=b-2) offering [group health insurance coverage](/usc/29/1191b.md?p=b-4), described in this paragraph is a [group health plan](/usc/29/1167.md?p=1) or coverage that—
    - (A) provides coverage for obstetric or gynecologic care; and
    - (B) requires the designation by a participant or beneficiary of a participating primary care provider.
  - (3) **Construction—** Nothing in [paragraph (1)](#c-1) shall be construed to—
    - (A) waive any exclusions of coverage under the terms and conditions of the plan or [health insurance coverage](/usc/29/1191b.md?p=b-1) with respect to coverage of obstetrical or gynecological care; or
    - (B) preclude the [group health plan](/usc/29/1167.md?p=1) or [health insurance issuer](/usc/29/1191b.md?p=b-2) involved from requiring that the obstetrical or gynecological provider notify the primary care health care professional or the plan or issuer of treatment decisions.

## Source credit

(Pub. L. 93–406, title I, § 722, as added Pub. L. 116–260, div. BB, title I, § 102(b)(2), Dec. 27, 2020, 134 Stat. 2783.)

## Notes

### Statutory Notes and Related Subsidiaries

### Effective Date

Section applicable with respect to plan years beginning on or after Jan. 1, 2022, see section 102(e) of div. BB of Pub. L. 116–260, set out as an Effective Date of 2020 Amendment note under section 8902 of Title 5, Government Organization and Employees.