C. If the examination specified in paragraph B reveals a gynecological condition for which another visit to the physician participating in the plan is medically required and appropriate, or for any gynecological care beyond the annual examination, the carrier may require the patient or the examining physician, certified nurse practitioner or certified nurse midwife to secure from the patient's primary care physician a referral to the participating physician, certified nurse practitioner or certified nurse midwife from whom such care may be obtained.

Sec. 3. 24-A MRSA §4241, sub-§1, as enacted by PL 1995, c. 617, §5 and affected by §6, is amended to read:

1. Coverage in managed care plans. With respect to managed care plans that require enrollees to select primary care physicians, a health maintenance organization that issues group policies and contracts must meet the following requirements.

A. The health maintenance organization must permit a physician who specializes in obstetrics and gynecology to serve as a primary care physician if the physician qualifies under the organization's credentialling policy.

B. All group plan contracts must provide coverage for an annual gynecological examination, including routine pelvic and clinical breast examinations, primary, preventive and therapeutic obstetrics and gynecological services indicated for a woman's health care and required as a result of a gynecological examination or as a result of a gynecological condition, performed by a physician, certified nurse practitioner or certified nurse midwife participating in the plan, without requiring the prior approval of the primary care physician.__The contract may require the participating obsterical-gynecological provider to provide written notice of the services provided and any treatment plan to the woman's primary care physician.