senate Bill S5895

2013-2014 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

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 08, 2014 referred to insurance
Jun 19, 2013 referred to rules

S5895 - Details

Current Committee:
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:
A7489B, S5068A

S5895 - Summary

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

S5895 - Sponsor Memo

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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