S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  1449

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                            February 2, 2009
                               ___________

Introduced  by  Sens.  MAZIARZ, GOLDEN, LITTLE, VOLKER -- read twice and
  ordered printed, and when printed to be committed to the Committee  on
  Insurance

AN  ACT  to  amend  the  insurance  law, in relation to health insurance
  coverage and to eligibility for employee benefits provided by employee
  welfare funds

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
amended by adding a new paragraph 26 to read as follows:
  (26) NO SUCH POLICY SHALL LIMIT BENEFITS  OR  DENY  REIMBURSEMENT  FOR
BENEFITS  TO  ANY  INSURED ON THE BASIS THAT THE PHARMACY PROVIDING SUCH
BENEFITS HAS NOT BEEN SPECIFICALLY SELECTED OR APPROVED. IF THE INSURED,
HIS DEPENDENTS OR BOTH RECEIVE SERVICES FROM A  PHARMACY  OF  THEIR  OWN
CHOOSING,  SUCH  INSURED  SHALL  PAY  THE  COST  OF  SUCH PHARMACEUTICAL
PRODUCTS TO THE EXTENT THAT SUCH  COST  EXCEEDS  THE  BENEFITS  PROVIDED
UNDER  THE POLICY WITHOUT FORFEITURE OF THE BENEFITS PROVIDED UNDER SUCH
POLICY. NO SUCH POLICY SHALL PROHIBIT A DULY  REGISTERED  PHARMACY  FROM
PROVIDING  SERVICES,  PROVIDED  SUCH  PHARMACY  AGREES  TO  PROVIDE SUCH
SERVICES IN ACCORDANCE WITH THE MINIMUM  STANDARDS  AND  CONDITIONS  FOR
SIMILAR PROVIDERS THAT HAVE BEEN ESTABLISHED BY SUCH POLICY.
  S 2. Subsection (e) of section 3221 of the insurance law is amended by
adding a new paragraph 12 to read as follows:
  (12)  NO  SUCH  GROUP  OR  BLANKET POLICY SHALL LIMIT BENEFITS OR DENY
REIMBURSEMENT FOR BENEFITS TO ANY INSURED ON THE BASIS THAT THE PHARMACY
PROVIDING SUCH BENEFITS HAS NOT BEEN SPECIFICALLY SELECTED  OR  APPROVED
BY  THE  GROUP OR BLANKET POLICY. IF THE INSURED, HIS DEPENDENTS OR BOTH
RECEIVE SERVICES FROM A PHARMACY OF THEIR  OWN  CHOOSING,  SUCH  INSURED
SHALL  PAY  THE  COST OF SUCH PHARMACEUTICAL PRODUCTS TO THE EXTENT THAT
SUCH COST EXCEEDS THE BENEFITS PROVIDED UNDER THE GROUP OR BLANKET POLI-
CY WITHOUT FORFEITURE OF THE BENEFITS PROVIDED UNDER SUCH GROUP OR BLAN-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01163-01-9
              

S. 1449                             2

KET POLICY. NO SUCH GROUP OR BLANKET POLICY SHALL PROHIBIT A DULY REGIS-
TERED PHARMACY FROM PROVIDING SERVICES, PROVIDED SUCH PHARMACY AGREES TO
PROVIDE SUCH SERVICES IN  ACCORDANCE  WITH  THE  MINIMUM  STANDARDS  AND
CONDITIONS  FOR  SIMILAR  PROVIDERS  THAT  HAVE BEEN ESTABLISHED BY SUCH
GROUP OR BLANKET POLICY.
  S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (ff) to read as follows:
  (FF)  NO  SUCH  POLICY  ISSUED  BY A THIRD PARTY BENEFIT PROGRAM SHALL
LIMIT BENEFITS OR DENY REIMBURSEMENT FOR SERVICES TO ANY INSURED ON  THE
BASIS  THAT  THE  PHARMACY  PROVIDING SUCH BENEFITS HAS NOT BEEN SPECIF-
ICALLY SELECTED OR APPROVED BY THE THIRD PARTY BENEFIT PROGRAM.  IF  THE
INSURED,  HIS  DEPENDENTS  OR  BOTH  RECEIVE SERVICES FROM A PHARMACY OF
THEIR OWN CHOOSING, SUCH INSURED SHALL PAY THE COST OF SUCH TREATMENT TO
THE EXTENT THAT SUCH COST EXCEEDS THE BENEFITS PROVIDED UNDER THE POLICY
WITHOUT FORFEITURE OF THE BENEFITS PROVIDED UNDER SUCH POLICY.  NO  SUCH
THIRD  PARTY  BENEFIT  PROGRAM SHALL PROHIBIT A DULY REGISTERED PHARMACY
FROM PROVIDING  SERVICES,  PROVIDED  SUCH  PHARMACY  AGREES  TO  PROVIDE
SERVICES  IN  ACCORDANCE  WITH  THE MINIMUM STANDARDS AND CONDITIONS FOR
SIMILAR PROVIDERS THAT HAVE BEEN ESTABLISHED BY SUCH THIRD PARTY BENEFIT
PROGRAM.
  S 4. Subsection (b) of section 4402 of the insurance law is amended to
read as follows:
  (b) "Employee benefits" means one or more  benefits  or  services  for
employees  or  their families or dependents, or for both, including, but
not limited to, medical, surgical or hospital care or benefits  PROVIDED
BY  OR  PERFORMED  BY  ANY  PHARMACY, benefits in the event of sickness,
accident, disability or death, benefits in the event of unemployment, or
retirement benefits.
  S 5. Subsection (b) of section 4413 of the insurance law is amended by
adding a new paragraph 1-a to read as follows:
  (1-A) NO SUCH FUND SHALL LIMIT EMPLOYEE BENEFITS OR DENY REIMBURSEMENT
FOR EMPLOYEE BENEFITS TO ANY ELIGIBLE EMPLOYEE ON  THE  BASIS  THAT  THE
PHARMACY  PROVIDING  SUCH BENEFITS HAS NOT BEEN SPECIFICALLY SELECTED OR
APPROVED BY THE WELFARE FUND, THE EMPLOYER  OR  THE  LABOR  ORGANIZATION
REPRESENTING  THE  EMPLOYEES ELIGIBLE FOR SUCH EMPLOYEE BENEFITS. IF THE
ELIGIBLE EMPLOYEE, HIS DEPENDENTS OR BOTH RECEIVE SERVICES FROM A  PHAR-
MACY  OF  THEIR  OWN  CHOOSING, SUCH EMPLOYEE SHALL PAY THE COST OF SUCH
TREATMENT TO THE EXTENT THAT SUCH COST  EXCEEDS  THE  BENEFITS  PROVIDED
UNDER  THE  PLAN  WITHOUT FORFEITURE OF THE BENEFITS PROVIDED UNDER SUCH
PLAN.  NO SUCH FUND, EMPLOYER OR LABOR  ORGANIZATION  SHALL  PROHIBIT  A
DULY  REGISTERED  PHARMACY    FROM PROVIDING EMPLOYEE BENEFITS, PROVIDED
SUCH PHARMACY AGREES TO PROVIDE SUCH SERVICES  IN  ACCORDANCE  WITH  THE
MINIMUM  STANDARDS  AND  CONDITIONS FOR SIMILAR PROVIDERS THAT HAVE BEEN
ESTABLISHED BY SUCH FUND, EMPLOYER OR LABOR ORGANIZATION.
  S 6. Subsection (b) of section 4301 of the insurance law is amended by
adding a new paragraph 4 to read as follows:
  (4) IF A CONTRACT ISSUED BY A THIRD  PARTY  BENEFIT  PROGRAM  PROVIDES
BENEFITS  FOR PHARMACY SERVICES, PRESCRIPTION DRUGS OR FOR PARTICIPATION
IN A PRESCRIPTION DRUG PLAN, ANY PHARMACY WILLING TO  PARTICIPATE  UNDER
THE  TERMS  OF  THE  CONTRACT SHALL NOT BE DENIED ACCESS TO THE PROVIDER
PANEL.
  S 7. This act shall take effect on the first of January next  succeed-
ing  the date on which it shall have become a law and shall apply to all
policies and contracts issued, renewed, modified, altered or amended  on
or after such effective date.