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

                                  2265

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            January 15, 2009
                               ___________

Introduced  by  M. of A. GOTTFRIED, GALEF -- Multi-Sponsored by -- M. of
  A. KELLNER, PHEFFER -- read once and  referred  to  the  Committee  on
  Health

AN ACT to amend the public health law and the insurance law, in relation
  to the insured's financial responsibility

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

  Section 1. Subdivision 2 of section 4406 of the public health  law  is
amended by adding a new paragraph (j) to read as follows:
  (J)  NOTWITHSTANDING  ANY INCONSISTENT PROVISION OF LAW OR REGULATION,
THE LIABILITY OF AN ENROLLEE FOR THE HOSPITAL  SERVICES  PROVIDED  BY  A
GENERAL  HOSPITAL  CERTIFIED  UNDER ARTICLE TWENTY-EIGHT OF THIS CHAPTER
WHERE THE GENERAL HOSPITAL IS A PARTICIPATING PROVIDER SHALL BE  LIMITED
TO  THE CO-PAYMENT, DEDUCTIBLE AND COINSURANCE AMOUNTS APPLICABLE TO THE
IN-NETWORK HOSPITAL BENEFIT AS SET FORTH IN  THE  CONTRACT  BETWEEN  THE
HEALTH  MAINTENANCE ORGANIZATION AND THE ENROLLEE, REGARDLESS OF WHETHER
THE ADMITTING PHYSICIAN OR TREATING PHYSICIAN OF RECORD IS A  NON-PARTI-
CIPATING  PROVIDER.  THE HEALTH MAINTENANCE ORGANIZATION SHALL REIMBURSE
THE GENERAL HOSPITAL FOR THE SERVICES PROVIDED BY THE  GENERAL  HOSPITAL
AT THE HEALTH MAINTENANCE ORGANIZATION'S FULL CONTRACTED RATE IN ACCORD-
ANCE  WITH THE IN-NETWORK POLICIES AND IN-NETWORK CO-PAYMENT, DEDUCTIBLE
OR COINSURANCE REQUIREMENTS  OF  THE  HEALTH  MAINTENANCE  ORGANIZATION,
REGARDLESS  OF  WHETHER THE ADMITTING PHYSICIAN OR TREATING PHYSICIAN OF
RECORD IS A NON-PARTICIPATING PROVIDER.
  S 2. The insurance law is amended by adding a new section 4806 to read
as follows:
  S 4806. REGULATION  OF  CONTRACTS.  NOTWITHSTANDING  ANY  INCONSISTENT
PROVISION  OF  LAW  OR  REGULATION,  IF AN INSURER OFFERS A MANAGED CARE
PRODUCT THAT PROVIDES FOR BOTH IN-NETWORK AND  OUT-OF-NETWORK  BENEFITS,
THE  LIABILITY  OF  AN  INSURED  FOR THE HOSPITAL SERVICES PROVIDED BY A
GENERAL HOSPITAL CERTIFIED UNDER  ARTICLE  TWENTY-EIGHT  OF  THE  PUBLIC

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01116-02-9
              

A. 2265                             2

HEALTH  LAW  WHERE  THE  GENERAL  HOSPITAL  IS A MEMBER OF THE INSURER'S
IN-NETWORK BENEFITS PORTION OF THE PROVIDER NETWORK SHALL BE LIMITED  TO
WHAT  THE  INSURED WOULD OTHERWISE PAY FOR IN-NETWORK HOSPITAL SERVICES,
REGARDLESS  OR  WHETHER THE ADMITTING PHYSICIAN OR TREATING PHYSICIAN OF
RECORD IS A MEMBER OF THE INSURER'S IN-NETWORK PORTION OF  THE  PROVIDER
NETWORK.  THE  INSURER  SHALL  REIMBURSE  THE  GENERAL  HOSPITAL FOR THE
SERVICES  PROVIDED  BY  THE  GENERAL  HOSPITAL  AT  THE  INSURER'S  FULL
CONTRACTED  RATE IN ACCORDANCE WITH THE IN-NETWORK BENEFITS POLICIES AND
IN-NETWORK CO-PAYMENT, DEDUCTIBLE OR  COINSURANCE  REQUIREMENTS  OF  THE
INSURER,  REGARDLESS  OF  WHETHER  THE  ADMITTING  PHYSICIAN OR TREATING
PHYSICIAN OF RECORD IS A NON-PARTICIPATING PROVIDER.
  S 3. This act shall take effect on January first next  succeeding  the
date  on  which it shall have become a law, and shall apply to all poli-
cies and contracts issued, renewed, modified, altered or amended  on  or
after such effective date.