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

                                  8494

                          I N  A S S E M B L Y

                            January 17, 2014
                               ___________

Introduced  by  M.  of  A.  ROSENTHAL  --  read once and referred to the
  Committee on Insurance

AN ACT to amend the insurance law and the public health law, in relation
  to requiring health care insurers to offer coverage  for  health  care
  provided by out-of-network providers

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Section 3217-e of the insurance law, as  added  by  chapter
219 of the laws of 2011, is amended to read as follows:
  S  3217-e.  Choice  of  health  care  provider. (A) An insurer that is
subject to this article and requires or provides for designation  by  an
insured  of  a  participating  primary  care  provider  shall permit the
insured to designate any participating  primary  care  provider  who  is
available  to  accept such individual, and in the case of a child, shall
permit the insured to designate a physician (allopathic or  osteopathic)
who  specializes  in  pediatrics as the child's primary care provider if
such provider participates in the network of the insurer.
  (B) EVERY INSURER THAT OFFERS HEALTH INSURANCE AND IS SUBJECT  TO  THE
PROVISIONS  OF  THIS  ARTICLE, SHALL OFFER OUT-OF-NETWORK COVERAGE AS AN
OPTIONAL RIDER TO ANY POLICY AND SHALL OFFER AT LEAST ONE POLICY  OPTION
THAT  INCLUDES  OUT-OF-NETWORK  COVERAGE.  THESE  OPTIONS  SHALL BE MADE
AVAILABLE BOTH WITHIN THE STATEWIDE HEALTH BENEFIT EXCHANGE AND  OUTSIDE
OF THE HEALTH BENEFIT EXCHANGE.
  S  2.  Section 4306-d of the insurance law, as added by chapter 219 of
the laws of 2011, is amended to read as follows:
  S 4306-d. Choice of health care provider. (A) A  corporation  that  is
subject  to  the provisions of this article and requires or provides for
designation by a subscriber of a  participating  primary  care  provider
shall  permit the subscriber to designate any participating primary care
provider who is available to accept such individual, and in the case  of
a child, shall permit the subscriber to designate a physician (allopath-
ic  or osteopathic) who specializes in pediatrics as the child's primary
care provider if such provider participates in the network of the corpo-
ration.

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

                                                           LBD13166-03-3

A. 8494                             2

  (B) EVERY CORPORATION THAT IS SUBJECT TO THE PROVISIONS OF THIS  ARTI-
CLE,  SHALL  OFFER  OUT-OF-NETWORK  COVERAGE AS AN OPTIONAL RIDER TO ANY
CONTRACT AND SHALL OFFER AT LEAST  ONE  CONTRACT  OPTION  THAT  INCLUDES
OUT-OF-NETWORK  COVERAGE.  THESE  OPTIONS  SHALL  BE MADE AVAILABLE BOTH
WITHIN  THE  STATEWIDE HEALTH BENEFIT EXCHANGE AND OUTSIDE OF THE HEALTH
BENEFIT EXCHANGE.
  S 3. Section 4403 of the public health law is amended by adding a  new
subdivision 9 to read as follows:
  9.  EVERY  HEALTH  MAINTENANCE ORGANIZATION SHALL OFFER OUT-OF-NETWORK
COVERAGE AS AN OPTIONAL RIDER TO ANY CONTRACT AND SHALL OFFER  AT  LEAST
ONE CONTRACT OPTION THAT INCLUDES OUT-OF-NETWORK COVERAGE. THESE OPTIONS
SHALL  BE  MADE  AVAILABLE  BOTH  WITHIN  THE  STATEWIDE  HEALTH BENEFIT
EXCHANGE AND OUTSIDE OF THE HEALTH BENEFIT EXCHANGE.
  S 4. 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
contracts and policies issued, renewed, modified or amended on or  after
such date.