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

                                  7930

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                             April 28, 2009
                               ___________

Introduced by M. of A. ABBATE, JOHN, PHEFFER, BOYLAND, GALEF, GABRYSZAK,
  JAFFEE  --  Multi-Sponsored by -- M. of A. BENEDETTO, COLTON, DESTITO,
  ESPAILLAT, GUNTHER, HIKIND, LANCMAN, MAISEL, MARKEY, MAYERSOHN, McENE-
  NY, MILLMAN, ORTIZ, PEOPLES, J. RIVERA, ROSENTHAL, SCHROEDER, SWEENEY,
  TOWNS, WRIGHT -- read once and referred 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-
KET POLICY. NO SUCH GROUP OR BLANKET POLICY SHALL PROHIBIT A DULY REGIS-

              

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

A. 7930                             2

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.