Senate Bill S3856

                                BILL NUMBER:S3856

TITLE OF BILL:  An act to amend the insurance law, in relation to
insurance coverage for out-of-network flu shots

PURPOSE:  To prohibit insurance policies from denying coverage for
individuals who receive a flu shot from an out-of-network provider.

SUMMARY OF PROVISIONS:

Section 1 adds out-of-network flu shot coverage to the list of
entitled reimbursements and coverages for every person insured under
accident and health insurance in this state.

Section 2 adds out-of-network flu shot coverage to the list of
standard provisions for group or blanket accident and health insurance
policies.

Section 3 adds out-of-network flu shot coverage to the list of
required benefits of non-profit medical and dental indemnity or health
and hospital service corporations.

Section 4 adds flu shots to the list of in-plan and out-of-plan
covered services for the standardized individual enrollee direct
payment contract.

              

Section 5 provides that the effective date is on the first of January
next succeeding the date on which it shall have become a law.

JUSTIFICATION:  The flu season, which lasts from roughly October
through May, increasingly threatens the health of New Yorkers. This
year the Governor declared a "state of emergency" as the total number
of cases soared to roughly 20,000 people, five times the number of
last season. Around 3,000 of these cases required hospitalization and
two people died.

This epidemic is easily avoidable with the flu vaccine ("flu shot"),
which reduces the adds of infection by 70% to 90%. Flu shots are
widely available through physicians and at many local pharmacies.
Unfortunately, many health insurance companies limit coverage to only
in-network providers, substantially inhibiting the ability of many New
Yorkers to take this important preventative measure due to expense
and/or inconvenience.

The bill increases access to the flu vaccine by requiring health
insurers to cover flu shots from both in-network and out-of-network
providers, thus protecting the health of New Yorkers.

LEGISLATIVE HISTORY: None.

FISCAL IMPLICATIONS:  None.

EFFECTIVE DATE:  This act shall take effect on the first of January
next succeeding the date on which it shall have become a law and shall
apply to insurance policies and contracts issued, renewed, modified or
altered on or after such effective date.