senate Bill S5068A

2011-2012 Legislative Session

Requires health plans with coverage of out of plan medical services to provide certain information to insureds, subscribers and enrollees

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Archive: Last Bill Status - In Committee


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Actions

view actions (5)
Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 10, 2012 reported and committed to insurance
Jan 05, 2012 print number 5068a
amend (t) and recommit to health
Jan 04, 2012 referred to health
May 03, 2011 referred to health

Votes

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Jan 10, 2012 - Health committee Vote

S5068A
15
0
committee
15
Aye
0
Nay
2
Aye with Reservations
0
Absent
0
Excused
0
Abstained
show Health committee vote details

Bill Amendments

Original
A (Active)
Original
A (Active)

Co-Sponsors

S5068 - Details

See Assembly Version of this Bill:
A7489B
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §4408, Pub Health L; amd §§3217-a & 4324, add §3240, Ins L

S5068 - Summary

Requires health plans providing coverage for out-of-network care to provide certain information to insureds, subscribers and enrollees.

S5068 - Sponsor Memo

S5068 - Bill Text download pdf

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

                                  5068

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                               May 3, 2011
                               ___________

Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health

AN ACT to amend the public health law and the insurance law, in relation
  to prohibiting the approval of a  health  care  plan  which  does  not
  provide coverage of out of network care

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

  Section 1. Paragraph (a) of subdivision  2  of  section  4406  of  the
public  health  law,  as  amended by chapter 504 of the laws of 1995, is
amended and two new paragraphs (j) and (k) are added to read as follows:
  (a) Upon approval of the commissioner, an organization  may  implement
an  out-of-plan  benefits  system that allows enrollees to use providers
not participating in the plan pursuant  to  a  contract,  employment  or
other  association.  The  commissioner,  in consultation with the super-
intendent, shall not approve an organization to implement an out-of-plan
benefits system unless the organization demonstrates that:
  (i) the requirements of this article and any  regulations  promulgated
thereunder have been met and will continue to be met;
  (ii)  it  can  establish and maintain a contingent reserve fund of not
less than two percent of the entire net premium income for the  calendar
year  of  the  organization  in addition to any other contingent reserve
fund required by the commissioner in regulations subject to the approval
of the superintendent; [and]
  (iii) it has established mechanisms to ensure and  monitor  compliance
with the provisions of paragraph (b) of this subdivision[.];
  (IV) THE OUT OF PLAN BENEFITS SYSTEM WILL PROVIDE SIGNIFICANT COVERAGE
OF THE USUAL COSTS OF OUT-OF-PLAN HEALTH SERVICES.
  (J)  AN  ORGANIZATION OFFERING AN OUT-OF-PLAN BENEFITS SYSTEM PURSUANT
TO THIS SUBDIVISION SHALL PROVIDE TO THEIR SUBSCRIBERS AND  ENROLLEES  A
DESCRIPTION  OF  ITS  METHODOLOGY  FOR REIMBURSING OUT-OF-PLAN BENEFITS,
WHICH  SHALL  BE  EXPRESSED  AS  A  PERCENTAGE  OF  THE  USUAL  COST  OF

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10981-01-1

Co-Sponsors

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S5068A (ACTIVE) - Details

See Assembly Version of this Bill:
A7489B
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §4408, Pub Health L; amd §§3217-a & 4324, add §3240, Ins L

S5068A (ACTIVE) - Summary

Requires health plans providing coverage for out-of-network care to provide certain information to insureds, subscribers and enrollees.

S5068A (ACTIVE) - Sponsor Memo

S5068A (ACTIVE) - Bill Text download pdf

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

                                 5068--A

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                               May 3, 2011
                               ___________

Introduced by Sens. HANNON, AVELLA, BALL, KRUEGER, MARTINS -- read twice
  and ordered printed, and when printed to be committed to the Committee
  on Health -- recommitted to the Committee on Health in accordance with
  Senate  Rule  6, sec. 8 -- committee discharged, bill amended, ordered
  reprinted as amended and recommitted to said committee

AN ACT to amend the insurance law and the public health law, in relation
  to requiring a health care plan which  provides  coverage  of  out  of
  network  care  to provide certain information to insureds, subscribers
  or enrollees

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

  Section  1.   Subsection (a) of section 3217-a of the insurance law is
amended by adding a new paragraph 18 to read as follows:
  (18) WHERE APPLICABLE, IF THE POLICY  OFFERS  OUT-OF-NETWORK  COVERAGE
APPROVED  BY  THE  SUPERINTENDENT PURSUANT TO SECTION THIRTY-TWO HUNDRED
FORTY OF THIS ARTICLE, A DESCRIPTION OF ITS METHODOLOGY FOR  REIMBURSING
OUT-OF-NETWORK  HEALTH  CARE  SERVICES  WHICH  SHALL BE SET FORTH AS THE
PERCENTAGE OF THE USUAL AND CUSTOMARY  COSTS  OF  OUT-OF-NETWORK  HEALTH
CARE  SERVICES  THE  POLICY WILL COVER. INCLUDED WITHIN THIS DESCRIPTION
SHALL BE EXAMPLES OF ANTICIPATED OUT  OF  PACKET  COSTS  FOR  FREQUENTLY
BILLED  OUT-OF-NETWORK  HEALTH  CARE SERVICES PROVIDED BY VARIOUS HEALTH
CARE PROVIDER SPECIALISTS. FOR THE PURPOSES OF THIS PARAGRAPH "USUAL AND
CUSTOMARY COSTS OF OUT-OF NETWORK HEALTH CARE SERVICES" SHALL  MEAN  THE
EIGHTIETH  PERCENTILE  OF  THE  ACTUAL CHARGES FOR A HEALTH CARE SERVICE
PERFORMED BY AN OUT-OF-NETWORK HEALTH CARE PROVIDER IN THE SAME OR SIMI-
LAR SPECIALITY, AND PROVIDED IN  THE  SAME  ZIP  CODE  OR  IN  THE  SAME
GEOGRAPHICAL  AREA  DEFINED  BY LOCALITIES WITH THE SAME FIRST THREE ZIP
CODE DIGITS, AS REPORTED IN A  BENCHMARKING  DATABASE  MAINTAINED  BY  A
NONPROFIT  ORGANIZATION  WITHOUT AFFILIATION WITH AN INSURER LICENSED TO
WRITE ACCIDENT AND HEALTH INSURANCE, A CORPORATION ORGANIZED PURSUANT TO
ARTICLE FORTY-THREE OF THIS CHAPTER, A HEALTH  MAINTENANCE  ORGANIZATION

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10981-05-2

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