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.