|Assembly Actions - Lowercase
Senate Actions - UPPERCASE
|Jan 08, 2014||referred to insurance|
|Jun 19, 2013||referred to rules|
senate Bill S5895
Archive: Last Bill Status - In Committee
- In Committee
- On Floor Calendar
- Passed Senate
- Passed Assembly
- Delivered to Governor
- Signed/Vetoed by Governor
S5895 - Details
S5895 - Summary
Requires health plans providing coverage for out-of-network care to provide certain information to insureds, subscribers and enrollees.
S5895 - Sponsor Memo
BILL NUMBER:S5895 TITLE OF BILL: 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 PURPOSE OR GENERAL IDEA OF BILL: To provide greater transparency and standardized disclosure of health insurance companies' out of network payment policies so that patients and employers can better understand the extent of their coverage. SUMMARY OF SPECIFIC PROVISIONS: Section 1 of the bill amends Section 3217-a of the Insurance Law to require all health insurance contracts; managed care health insurance contracts; or any other health insurance contract or product for which the superintendent deems appropriate to disclose to its subscribers and enrollees a description of its methodology for reimbursing health care treatment by physicians not participating in the plan's network, which shall be expressed as a percentage of the usual cost of care provided by physicians not participating in the health plan's network of providers (as determined by a nonprofit bench-marking database known as FAIR Health). Moreover, this section would also require a health insurance company to disclose to their enrollees upon request
S5895 - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 5895 2013-2014 Regular Sessions I N S E N A T E June 19, 2013 ___________ Introduced by Sen. RIVERA -- read twice and ordered printed, and when printed to be committed to the Committee on Rules 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 CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW, CREATED AS A RESULT OF SETTLEMENTS ENTERED INTO DURING THE YEAR TWO EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01205-01-3
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