---
kind: "section"
citation: "42 U.S.C. § 300gg–19a"
title: "42"
title_heading: "The Public Health and Welfare"
number: "300gg–19a"
heading: "Patient protections"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/300gg-19a"
units:
  - "Chapter 6A — Public Health Service"
  - "Subchapter XXV — Requirements Relating to Health Insurance Coverage"
  - "Part A — Individual and Group Market Reforms"
  - "Subpart II — Improving Coverage"
---

# §300gg–19a. Patient protections

- (a) **Choice of health care professional—** If a [group health plan](/usc/42/300bb–8.md?p=1), or a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5), requires or provides for designation by a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee of a participating primary care [provider](/usc/42/299b–21.md?p=8), then the plan or issuer shall permit each [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), and enrollee to designate any participating primary care [provider](/usc/42/299b–21.md?p=8) who is available to accept such individual.
- (b) **Coverage of emergency services—**
  - (1) **In general—** If a [group health plan](/usc/42/300bb–8.md?p=1), or a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering group or individual [health insurance issuer](/usc/42/300gg–91.md?p=b-2),[^1] provides or covers any benefits with respect to [services](/usc/42/201.md?p=a) in an emergency department of a [hospital](/usc/42/300s–3.md?p=1), the plan or issuer shall cover emergency [services](/usc/42/201.md?p=a) (as defined in [paragraph (2)(B)](#b-2-B))—
    - (A) without the need for any prior authorization determination;
    - (B) whether the [health care provider](/usc/42/300aa–33.md?p=1) furnishing such [services](/usc/42/201.md?p=a) is a participating [provider](/usc/42/299b–21.md?p=8) with respect to such [services](/usc/42/201.md?p=a);
    - (C) in a manner so that, if such [services](/usc/42/201.md?p=a) are provided to a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee—
      - (i) by a nonparticipating [health care provider](/usc/42/300aa–33.md?p=1) with or without prior authorization; or
      - (ii)
        - (I) such [services](/usc/42/201.md?p=a) will be provided without imposing any requirement under the plan for prior authorization of [services](/usc/42/201.md?p=a) or any limitation on coverage where the [provider](/usc/42/299b–21.md?p=8) of [services](/usc/42/201.md?p=a) does not have a contractual relationship with the plan for the providing of [services](/usc/42/201.md?p=a) that is more restrictive than the requirements or limitations that apply to emergency department [services](/usc/42/201.md?p=a) received from [providers](/usc/42/299b–21.md?p=8) who do have such a contractual relationship with the plan; and
        - (II) if such [services](/usc/42/201.md?p=a) are provided out-of-network, the cost-sharing requirement (expressed as a copayment amount or coinsurance rate) is the same requirement that would apply if such [services](/usc/42/201.md?p=a) were provided in-network;[^2]
    - (D) without regard to any other term or condition of such coverage (other than exclusion or coordination of benefits, or an affiliation or waiting period, permitted under [section 2701](/usc/42/2701.md)[^3] of this Act, [section 1181 of title 29](/usc/29/1181.md), or [section 9801 of title 26](/usc/26/9801.md), and other than applicable cost-sharing).
  - (2) **Definitions—** In this subsection:
    - (A) **Emergency medical condition—** The term “emergency medical condition” means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in a condition described in clause (i), (ii), or (iii) of [section 1395dd(e)(1)(A) of this title](/usc/42/1395dd.md?p=e-1-A).
    - (B) **Emergency services—** The term “emergency [services](/usc/42/201.md?p=a)” means, with respect to an emergency medical condition—
      - (i) a medical screening examination (as required under [section 1395dd of this title](/usc/42/1395dd.md)) that is within the capability of the emergency department of a [hospital](/usc/42/300s–3.md?p=1), including ancillary [services](/usc/42/201.md?p=a) routinely available to the emergency department to evaluate such emergency medical condition, and
      - (ii) within the capabilities of the staff and facilities available at the [hospital](/usc/42/300s–3.md?p=1), such further medical examination and [treatment](/usc/42/11851.md?p=11) as are required under [section 1395dd of this title](/usc/42/1395dd.md) to stabilize the patient.
    - (C) **Stabilize—** The term “to stabilize”, with respect to an emergency medical condition (as defined in [subparagraph (A)](#b-2-A)), has the meaning give[^4] in [section 1395dd(e)(3) of this title](/usc/42/1395dd.md?p=e-3).
- (c) **Access to pediatric care—**
  - (1) **Pediatric care—** In the case of a person who has a child who is a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee under a [group health plan](/usc/42/300bb–8.md?p=1), or [health insurance coverage](/usc/42/300gg–91.md?p=b-1) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) in the group or [individual market](/usc/42/300gg–91.md?p=e-1-A), if the plan or issuer requires or provides for the designation of a participating primary care [provider](/usc/42/299b–21.md?p=8) for the child, the plan or issuer shall permit such person to designate a physician (allopathic or osteopathic) who specializes in pediatrics as the child’s primary care [provider](/usc/42/299b–21.md?p=8) if such [provider](/usc/42/299b–21.md?p=8) participates in the network of the plan or issuer.
  - (2) **Construction—** Nothing in [paragraph (1)](#c-1) shall be construed to waive any exclusions of coverage under the terms and conditions of the plan or [health insurance coverage](/usc/42/300gg–91.md?p=b-1) with respect to coverage of pediatric care.
- (d) **Patient access to obstetrical and gynecological care—**
  - (1) **General rights—**
    - (A) **Direct access—** A [group health plan](/usc/42/300bb–8.md?p=1), or [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5), described in [paragraph (2)](#d-2) may not require authorization or referral by the plan, issuer, or any person (including a primary care [provider](/usc/42/299b–21.md?p=8) described in [paragraph (2)(B)](#d-2-B)) in the case of a female [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee 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](/usc/42/201.md?p=a) pursuant to a [treatment](/usc/42/11851.md?p=11) plan (if any) approved by the plan or issuer.
    - (B) **Obstetrical and gynecological care—** A [group health plan](/usc/42/300bb–8.md?p=1) or [health insurance issuer](/usc/42/300gg–91.md?p=b-2) described in [paragraph (2)](#d-2) shall treat the provision of obstetrical and gynecological care, and the ordering of related obstetrical and gynecological items and [services](/usc/42/201.md?p=a), pursuant to the direct access described under [subparagraph (A)](#d-1-A), by a participating health care professional who specializes in obstetrics or gynecology as the authorization of the primary care [provider](/usc/42/299b–21.md?p=8).
  - (2) **Application of paragraph—** A [group health plan](/usc/42/300bb–8.md?p=1), or [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5), described in this paragraph is a [group health plan](/usc/42/300bb–8.md?p=1) or coverage that—
    - (A) provides coverage for obstetric or gynecologic care; and
    - (B) requires the designation by a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee of a participating primary care [provider](/usc/42/299b–21.md?p=8).
  - (3) **Construction—** Nothing in [paragraph (1)](#d-1) shall be construed to—
    - (A) waive any exclusions of coverage under the terms and conditions of the plan or [health insurance coverage](/usc/42/300gg–91.md?p=b-1) with respect to coverage of obstetrical or gynecological care; or
    - (B) preclude the [group health plan](/usc/42/300bb–8.md?p=1) or [health insurance issuer](/usc/42/300gg–91.md?p=b-2) involved from requiring that the obstetrical or gynecological [provider](/usc/42/299b–21.md?p=8) notify the primary care health care professional or the plan or issuer of [treatment](/usc/42/11851.md?p=11) decisions.
- (e) **Application—** The provisions of this section shall not apply with respect to a [group health plan](/usc/42/300bb–8.md?p=1), [health insurance issuers](/usc/42/300gg–91.md?p=b-2), or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) with respect to plan years beginning on or on[^5] January 1, 2022.

## Footnotes

[^1]: So in original. Probably should be “coverage,”.
[^2]: So in original. The word “and” probably should appear.
[^3]: See References in Text note below.
[^4]: So in original. Probably should be “given”.
[^5]: So in original.

## Source credit

(July 1, 1944, ch. 373, title XXVII, § 2719A, as added Pub. L. 111–148, title X, § 10101(h), Mar. 23, 2010, 124 Stat. 888; amended Pub. L. 116–260, div. BB, title I, § 102(a)(3)(A), Dec. 27, 2020, 134 Stat. 2771.)

## Notes

### Editorial Notes

### References in Text

Section 2701 of this Act, referred to in subsec. (b)(1)(D), is a reference to section 2701 of act July 1, 1944. Section 2701, which was classified to section 300gg of this title, was renumbered section 2704, effective for plan years beginning on or after Jan. 1, 2014, with certain exceptions, and amended, by Pub. L. 111–148, title I, §§ 1201(2), 1563(c)(1), formerly § 1562(c)(1), title X, § 10107(b)(1), Mar. 23, 2010, 124 Stat. 154, 264, 911, and was transferred to section 300gg–3 of this title. A new section 2701 of act July 1, 1944, related to fair health insurance premiums, was added, effective for plan years beginning on or after Jan. 1, 2014, and amended, by Pub. L. 111–148, title I, § 1201(4), title X, § 10103(a), Mar. 23, 2010, 124 Stat. 155, 892, and is classified to section 300gg of this title.

### Codification

Pub. L. 111–148, which directed amendment of subpart II of part A of “title XVIII” of act July 1, 1944, by inserting section 2719A after section 2719, was executed by making the insertion in subpart II of part A of title XXVII of the Act, to reflect the probable intent of Congress.

### Amendments

2020—Subsec. (e). Pub. L. 116–260 added subsec. (e).

### Statutory Notes and Related Subsidiaries

### Effective Date of 2020 Amendment

Amendment by Pub. L. 116–260 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 a note under section 8902 of Title 5, Government Organization and Employees.