Senate Bill S1053

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

                                  1053

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                            January 22, 2009
                               ___________

Introduced  by Sens. MAZIARZ, FLANAGAN, GOLDEN, VOLKER -- 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 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 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 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 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.
                                                           LBD01170-01-9
              

S. 1053                             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 (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 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.