Patient Protection and Affordable Care Act Patient Protection Notice

OMB 1210-0142

OMB 1210-0142

The Patient Protection Notice is used by health plan sponsors and issuers to notify certain individuals of their right to (1) choose a primary care provider or a pediatrician when a plan or issuer requires participants or subscribers to designate a primary care physician; or (2) obtain obstetrical or gynecological care without prior authorization.

The latest form for Patient Protection and Affordable Care Act Patient Protection Notice expires 2022-05-31 and can be found here.

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