senate Bill S1106

Provides that health insurance coverage may not deny reimbursements because the registered laboratory providing laboratory services has not been approved

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 09 / Jan / 2013
    • REFERRED TO INSURANCE
  • 08 / Jan / 2014
    • REFERRED TO INSURANCE

Summary

Provides that health insurance coverage may not deny reimbursements because the registered laboratory providing laboratory services has not been approved by the insurer or other entity; provides that in such case the insured pays excess costs therefor above the covered benefit.

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Bill Details

Versions:
S1106
Legislative Cycle:
2013-2014
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd ยงยง3216, 3221, 4303, 4402, 4413 & 4301, Ins L
Versions Introduced in Previous Legislative Cycles:
2011-2012: S176
2009-2010: S1053

Sponsor Memo

BILL NUMBER:S1106

TITLE OF BILL:
An act
to amend the insurance law, in relation to health insurance coverage and
eligibility for employee benefits provided by employee welfare funds for
laboratory services

PURPOSE:
To prohibit the denial of health insurance coverage for
pharmaceuticals strictly because the registered pharmacy providing
the pharmaceutical products has not been approved by the health
insurance plan.

SUMMARY OF PROVISIONS:
Amends sections 3216, 3221, 4301, 4303, 4402
and 4413 of the New York State Insurance Law to provide that health
insurance coverage providers may not deny reimbursements because the
registered pharmacy providing pharmaceutical products has not been
approved by the insurer or other entity.

This amendment would require individuals who select a pharmacy that is
not part of the insurer's panel to be responsible for paying any
differential between the benefits provided under the health care
insurance contract and the cost of the services selected.. The fund,
employer' or union would be precluded from denying eligibility for
reimbursement to any registered pharmacy which is willing to meet
minimum standard conditions per participation requirements of the fund.

JUSTIFICATION:
Individuals and families should not be denied the
ability to obtain services from a registered pharmacy of their choice
simply on the basis of their membership in the health insurance plan
made available to them. A personal choice is being taken away from
an insured when they are directed to only obtain services from a
specified pharmacy rather than to the pharmacist they have sought
services from their entire lives. The insured may be more comfortable
with a pharmacist that he/she has come to know and rely upon and who
is familiar with their health history. Further, limiting
participating pharmacies is particularly difficult for insureds
living in rural areas who may have to travel miles to a pharmacy and
for the homebound.

This bill ensures that insureds will be able to access any registered
pharmacy that is willing to provide service in accordance with the
minimum criteria established by the health insurance contract.

This bill allows the insured freedom of choice and limits the
financial exposure of the insurer as well as that of an employee
welfare fund to the level of benefits agreed to between the
bargaining agent of the employee and the employer. The insurer would
not be required to provide the benefit to anyone that is not already
insured, nor would the insurer be required to reimburse pharmacies at
a higher rate than it reimburses participating providers. This bill
would simply require the insurer to reimburse any "duly registered


pharmacy" of the insured's choosing, instead of a limited number of
pharmacies of the insurance company's choosing.

LEGISLATIVE HISTORY:
S.176 of 2011/2012; Referred to Senate Insurance Committee
S.1053/A.509D of 2009/2010; Referred to Senate Insurance Committee
S.48/A.6728 of 2007/2008; Referred to Senate Insurance Committee
S19132/A.10403 of 2005/2006; Referred to Senate Insurance Committee
S.5878/A.4439 of 2003/2004; Referred to Senate Insurance Committee

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
Effective on January 1, next succeeding passage, and
shall apply to all policies and contracts issued, modified, altered
or amended thereafter.

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

                                  1106

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  Sen. MAZIARZ -- 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  eligibility  for employee benefits provided by employee
  welfare funds for laboratory services

  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 30 to read as follows:
  (30) NO SUCH POLICY SHALL LIMIT BENEFITS  OR  DENY  REIMBURSEMENT  FOR
BENEFITS  TO ANY INSURED ON THE BASIS THAT THE LABORATORY PROVIDING SUCH
BENEFITS HAS NOT BEEN SPECIFICALLY SELECTED OR APPROVED. IF THE INSURED,
HIS OR HER DEPENDENTS OR BOTH RECEIVE  SERVICES  FROM  A  LABORATORY  OF
THEIR  OWN  CHOOSING, SUCH INSURED SHALL PAY THE COST OF SUCH LABORATORY
SERVICES 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 LABORATORY  FROM
PROVIDING  SERVICES,  PROVIDED  SUCH  LABORATORY  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 13 to read as follows:
  (13)  NO  SUCH  GROUP  OR  BLANKET POLICY SHALL LIMIT BENEFITS OR DENY
REIMBURSEMENT FOR BENEFITS TO ANY INSURED ON THE BASIS THAT THE  LABORA-
TORY  PROVIDING  SUCH  BENEFITS  HAS  NOT  BEEN SPECIFICALLY SELECTED OR
APPROVED BY THE GROUP OR BLANKET POLICY. IF  THE  INSURED,  HIS  OR  HER
DEPENDENTS  OR  BOTH  RECEIVE  SERVICES  FROM  A LABORATORY OF THEIR OWN
CHOOSING, SUCH INSURED SHALL PAY THE COST OF SUCH LABORATORY SERVICES TO
THE EXTENT THAT SUCH COST EXCEEDS THE BENEFITS PROVIDED UNDER THE  GROUP
OR BLANKET POLICY WITHOUT FORFEITURE OF THE BENEFITS PROVIDED UNDER SUCH

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02288-01-3

S. 1106                             2

GROUP  OR BLANKET POLICY. NO SUCH GROUP OR BLANKET POLICY SHALL PROHIBIT
A DULY REGISTERED LABORATORY  FROM  PROVIDING  SERVICES,  PROVIDED  SUCH
LABORATORY  AGREES TO PROVIDE SUCH SERVICES IN ACCORDANCE WITH THE MINI-
MUM STANDARDS AND CONDITIONS FOR SIMILAR PROVIDERS THAT HAVE BEEN ESTAB-
LISHED BY SUCH GROUP OR BLANKET POLICY.
  S  3.  Section  4303  of  the insurance law is amended by adding a new
subsection (jj) to read as follows:
  (JJ) 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 LABORATORY PROVIDING SUCH BENEFITS HAS NOT  BEEN  SPECIF-
ICALLY  SELECTED  OR APPROVED BY THE THIRD PARTY BENEFIT PROGRAM. IF THE
INSURED, HIS OR HER DEPENDENTS OR BOTH RECEIVE SERVICES FROM A LABORATO-
RY OF THEIR OWN CHOOSING, SUCH INSURED SHALL PAY THE COST OF SUCH TREAT-
MENT TO THE EXTENT THAT SUCH COST EXCEEDS THE  BENEFITS  PROVIDED  UNDER
THE  POLICY WITHOUT FORFEITURE OF THE BENEFITS PROVIDED UNDER SUCH POLI-
CY. NO SUCH THIRD PARTY BENEFIT PROGRAM SHALL PROHIBIT A DULY REGISTERED
LABORATORY FROM PROVIDING SERVICES, PROVIDED SUCH LABORATORY  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 LABORATORY, 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
LABORATORY 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 OR HER DEPENDENTS OR BOTH RECEIVE SERVICES FROM A
LABORATORY  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 LABORATORY FROM PROVIDING EMPLOYEE BENEFITS,
PROVIDED SUCH LABORATORY 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 LABORATORY SERVICES, ANY LABORATORY 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.

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