Assembly Bill A9130

                                BILL NUMBER:A9130A

TITLE OF BILL:  An act to amend the insurance law, in relation to
requiring insurance companies to disclose claims information to munici-
palities

PURPOSE OR GENERAL IDEA OF BILL: This bill allows the different levels
of government an opportunity to assess accurately the true needs of
their employees when addressing health care benefits. This bill will
allow these governments to negotiate more effectively with all insurance
companies that are bidding on future contracts.

SUMMARY OF SPECIFIC PROVISIONS:  Section 1. Amends the insurance law by
adding a new section 3217-e to read as follows:

A. Every insurer contracting with municipalities, including cooperative
health benefit plans certified pursuant to article forty-seven of this
chapter, shall provide upon request the following information to the
insured municipality.

1. Specific claims information must be furnished by the insurer under
community rated and experience rated policies;

2. Average annual per member cost of claims reimbursement;

3. Number of members that did not file a claim within a 12 month period;
              

4. A comparison or emergency services used by members to out-patient
services; and

5. Any other information the municipality requests to determine use of
benefits by members.

B. The superintendent shall impose a fine of three hundred thousand
dollars for failure to provide within thirty days of a written request
by the insured municipality the information required by paragraph one of
subsection (a) of this section regarding the insured employees. A fine
of ten thousand dollars a day will be imposed for every day such failure
continues. Any fines imposed shall be paid directly to the municipality
requesting such information.

C. All information being released shall be done so in compliance with
the federal health insurance portability and accountability act (HIPAA)
or 1996.

Definition

The experience ratings will include all quantitative measures used by
the insurance company such as expenses per member, data supporting said
expenses and any historical data that will help determine the risk of
future claims. This information_will provide transparency for purposes
of negotiations in future contracts.

JUSTIFICATION: Every year villages, towns, cities and counties in New
York State are forced to put in place a budget that best meets the needs
of those governments. It is necessary for those creating budgets to have
access to accurate numbers that reflect a true need.  Without under-
standing how well health care programs are being utilized, it is very
difficult to negotiate in good faith with insurance carriers. Large
insurance carriers will continue to have an unfair advantage over
governments until transparencies exist and negotiations reflect actual
cost.

PRIOR LEGISLATIVE HISTORY: New Legislation

FISCAL IMPLICATIONS: None to New York State

EFFECTIVE DATE: This act will take effect immediately after passage.

                                BILL NUMBER:A9130B

TITLE  OF  BILL:    An  act to amend the insurance law, in relation to
requiring  insurance  companies  to  disclose  claims  information  to
municipalities

PURPOSE OR GENERAL IDEA OF BILL: This bill allows the different levels
of  government  employing 400 or more workers an opportunity to assess
accurately the true needs of their employees  when  addressing  health
care  benefits. It will create transparency allowing these governments
to negotiate more effectively with all insurance  companies  that  are
bidding on future contracts.

SUMMARY  OF  SPECIFIC PROVISIONS:  Section 1. Amends the insurance law
by adding a new section 3217-c to read as follows:

§3217-c Disclosure of information,to municipalities. (a) Every insurer
contracting with municipalities, including cooperative health  benefit
plans  certified pursuant to article forty-seven of this chapter shall
provide  upon  request  the  following  information  to  the   insured
municipality.

1.  Specific claims information must be furnished by the insurer under
community rated or experience rated policies;

2. Average annual per member cost of claims reimbursement;
              

3. Number of members that did not file  a  claim  within  a  12  month
period;

4.  A  comparison of emergency services used by members to out-patient
services; and

5. Provide municipality with loss ratio report

6. Claims history  for  the  last  12  months  must  be  provided  for
experience rated plans separated by medical and prescription.

7  Information regarding cost on to 25 prescription drug being used by
member employees.

8. Large loss claims report indicating  diagnosis  and  prognosis  for
claims greater than $30 000.00.

9. Medical loss ratio report.

10.  Any  other  statistical  information the municipality requests to
determine use of benefits by members.

B. The superintendent shall impose a fine of  three  hundred  thousand
dollars for failure to provide within thirty days of a written request
by  the insured municipality the information required by paragraph one
of subsection (a) of this section regarding the insured  employees.  A
fine  of ten thousand dollars a day will be imposed for every day such
failure continues, Any fines imposed shall be  paid  directly  to  the
municipality requesting such information.


C.  All information being released shall be done so in compliance with
the  federal  health  insurance  portability  and  accountability  act
(HIPAA) of 1996.

Definition

The  experience ratings will include all quantitative measures used by
the insurance company such as expenses  per  member,  data  supporting
said  expenses  and  any  historical data that will help determine the
risk of future claims. This information will provide transparency  for
purposes of negotiations in future contracts.

JUSTIFICATION:  Every year villages, towns, cities and counties in New
York State are forced to put in place a budget  that  best  meets  the
needs of those governments. It is necessary for those creating budgets
to  have access to accurate numbers that reflect a true need.  Without
understanding how well health care programs are being utilized, it  is
very  difficult  to  negotiate  in good faith with insurance carriers.
Large insurance carriers will continue to  have  an  unfair  advantage
over  governments  until transparencies exist and negotiations reflect
actual cost.

PRIOR LEGISLATIVE HISTORY: New Legislation

FISCAL IMPLICATIONS: None to New York State

EFFECTIVE DATE: This act will take effect immediately.