Assembly Bill A5216

2013-2014 Legislative Session

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

download bill text pdf

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Archive: Last Bill Status - Stricken


  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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2013-A5216 (ACTIVE) - Details

See Senate Version of this Bill:
S5895
Law Section:
Insurance Law
Laws Affected:
Amd §§3217-a & 4324, add §3240, Ins L; amd §4408, Pub Health L
Versions Introduced in 2011-2012 Legislative Session:
A7489, S5068

2013-A5216 (ACTIVE) - Summary

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

2013-A5216 (ACTIVE) - Bill Text download pdf

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

                                  5216

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                            February 21, 2013
                               ___________

Introduced  by  M.  of  A.  GOTTFRIED,  SCHIMEL, WEPRIN, TITONE, JACOBS,
  PAULIN, COLTON, CLARK, QUART, ABINANTI, ENGLEBRIGHT, GUNTHER,  JAFFEE,
  STEVENSON,  ZEBROWSKI,  MAISEL,  GALEF, ROBERTS, THIELE -- Multi-Spon-
  sored by -- M. of A. ARROYO, HOOPER, LAVINE, LENTOL, LUPARDO, MONTESA-
  NO, RA, RAIA, SKARTADOS, SWEENEY -- read  once  and  referred  to  the
  Committee on Health

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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01205-01-3
              

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