S T A T E   O F   N E W   Y O R K
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                                  4151

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                            January 29, 2015
                               ___________

Introduced  by  M.  of  A.  DenDEKKER  --  read once and referred to the
  Committee on Insurance

AN ACT to amend the insurance  law,  in  relation  to  health  insurance
  coverage for clinical 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 32 to read as follows:
  (32)  NO SUCH POLICY SHALL LIMIT OR DENY REIMBURSEMENT FOR BENEFITS TO
ANY INSURED ON THE BASIS THAT A LABORATORY PROVIDING CLINICAL LABORATORY
SERVICES IS AN OUT-OF-NETWORK PROVIDER, IF  AN  IN-NETWORK  HEALTH  CARE
PROVIDER  DIRECTS  SPECIMENS  RETRIEVED  BY SUCH HEALTH CARE PROVIDER TO
SUCH OUT-OF-NETWORK LABORATORY OR SUCH HEALTH CARE PROVIDER DIRECTS  THE
INSURED  TO  SUCH  OUT-OF-NETWORK  LABORATORY  FOR  CLINICAL  LABORATORY
SERVICES. 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 9 to read as follows:
  (9) NO SUCH GROUP OR BLANKET POLICY SHALL LIMIT OR DENY  REIMBURSEMENT
FOR  BENEFITS  TO  ANY  INSURED ON THE BASIS THAT A LABORATORY PROVIDING
CLINICAL LABORATORY  SERVICES  IS  AN  OUT-OF-NETWORK  PROVIDER,  IF  AN
IN-NETWORK  HEALTH  CARE  PROVIDER  DIRECTS  SPECIMENS RETRIEVED BY SUCH
HEALTH CARE PROVIDER TO SUCH OUT-OF-NETWORK LABORATORY  OR  SUCH  HEALTH
CARE  PROVIDER DIRECTS THE INSURED TO SUCH OUT-OF-NETWORK LABORATORY FOR
CLINICAL LABORATORY SERVICES. 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
MINIMUM  STANDARDS  AND  CONDITIONS FOR SIMILAR PROVIDERS THAT HAVE BEEN
ESTABLISHED BY SUCH GROUP OR BLANKET POLICY.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07988-01-5
              

A. 4151                             2

  S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (pp) to read as follows:
  (PP)  NO  SUCH  POLICY  ISSUED  BY A THIRD PARTY BENEFIT PROGRAM SHALL
LIMIT OR DENY REIMBURSEMENT FOR BENEFITS TO ANY  INSURED  ON  THE  BASIS
THAT   A   LABORATORY  PROVIDING  CLINICAL  LABORATORY  SERVICES  IS  AN
OUT-OF-NETWORK PROVIDER, IF AN IN-NETWORK HEALTH CARE  PROVIDER  DIRECTS
SPECIMENS  RETRIEVED BY SUCH HEALTH CARE PROVIDER TO SUCH OUT-OF-NETWORK
LABORATORY OR SUCH HEALTH CARE PROVIDER  DIRECTS  THE  INSURED  TO  SUCH
OUT-OF-NETWORK  LABORATORY  FOR  CLINICAL  LABORATORY  SERVICES. NO SUCH
THIRD PARTY BENEFIT PROGRAM 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 THIRD PARTY BENEFIT
PROGRAM.
  S 4. 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.