senate Bill S3856

2013-2014 Legislative Session

Provides for out-of-network coverage for flu shots

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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

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 08, 2014 referred to insurance
Feb 25, 2013 referred to insurance

S3856 - Bill Details

Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd ยงยง3216, 3221, 4303 & 4322, Ins L

S3856 - Bill Texts

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Provides for out-of-network coverage for flu shots.

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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.


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

                                  3856

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            February 25, 2013
                               ___________

Introduced  by  Sen. BRESLIN -- 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 insurance coverage for
  out-of-network flu shots

  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 30 to read as follows:
  (30) EVERY POLICY THAT INCLUDES COVERAGE FOR A FLU SHOT THAT  REQUIRES
SUCH  SERVICES  TO  BE PROVIDED BY AN IN-NETWORK PROVIDER SHALL NOT DENY
COVERAGE FOR AN INDIVIDUAL WHO RECEIVES THE FLU SHOT FROM AN OUT-OF-NET-
WORK PROVIDER.
  S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 19 to read as follows:
  (19) EVERY POLICY THAT INCLUDES COVERAGE FOR A FLU SHOT THAT  REQUIRES
SUCH  SERVICES  TO  BE PROVIDED BY AN IN-NETWORK PROVIDER SHALL NOT DENY
COVERAGE FOR AN INDIVIDUAL WHO RECEIVES THE FLU SHOT FROM AN OUT-OF-NET-
WORK PROVIDER.
  S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (jj) to read as follows:
  (JJ)  EVERY POLICY THAT INCLUDES COVERAGE FOR A FLU SHOT THAT REQUIRES
SUCH SERVICES TO BE PROVIDED BY AN IN-NETWORK PROVIDER  SHALL  NOT  DENY
COVERAGE FOR AN INDIVIDUAL WHO RECEIVES THE FLU SHOT FROM AN OUT-OF-NET-
WORK PROVIDER.
  S 4. Subsection (b) of section 4322 of the insurance law is amended by
adding a new paragraph 28 to read as follows:
  (28) FLU SHOTS.
  S  5. 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
insurance policies and contracts issued, renewed, modified or altered on
or after such effective date.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09240-01-3

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