S T A T E O F N E W Y O R K
________________________________________________________________________
4151
2015-2016 Regular Sessions
I N A S S E M B L Y
January 29, 2015
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Introduced by M. of A. DenDEKKER -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law, in relation to health insurance
coverage for clinical laboratory services
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 32 to read as follows:
(32) NO SUCH POLICY SHALL LIMIT OR DENY REIMBURSEMENT FOR BENEFITS TO
ANY INSURED ON THE BASIS THAT A LABORATORY PROVIDING CLINICAL LABORATORY
SERVICES IS AN OUT-OF-NETWORK PROVIDER, IF AN IN-NETWORK HEALTH CARE
PROVIDER DIRECTS SPECIMENS RETRIEVED BY SUCH HEALTH CARE PROVIDER TO
SUCH OUT-OF-NETWORK LABORATORY OR SUCH HEALTH CARE PROVIDER DIRECTS THE
INSURED TO SUCH OUT-OF-NETWORK LABORATORY FOR CLINICAL LABORATORY
SERVICES. NO SUCH POLICY SHALL PROHIBIT A DULY REGISTERED LABORATORY
FROM PROVIDING SERVICES, PROVIDED SUCH LABORATORY AGREES TO PROVIDE SUCH
SERVICES IN ACCORDANCE WITH THE MINIMUM STANDARDS AND CONDITIONS FOR
SIMILAR PROVIDERS THAT HAVE BEEN ESTABLISHED BY SUCH POLICY.
S 2. Subsection (e) of section 3221 of the insurance law is amended by
adding a new paragraph 9 to read as follows:
(9) NO SUCH GROUP OR BLANKET POLICY SHALL LIMIT OR DENY REIMBURSEMENT
FOR BENEFITS TO ANY INSURED ON THE BASIS THAT A LABORATORY PROVIDING
CLINICAL LABORATORY SERVICES IS AN OUT-OF-NETWORK PROVIDER, IF AN
IN-NETWORK HEALTH CARE PROVIDER DIRECTS SPECIMENS RETRIEVED BY SUCH
HEALTH CARE PROVIDER TO SUCH OUT-OF-NETWORK LABORATORY OR SUCH HEALTH
CARE PROVIDER DIRECTS THE INSURED TO SUCH OUT-OF-NETWORK LABORATORY FOR
CLINICAL LABORATORY SERVICES. NO SUCH GROUP OR BLANKET POLICY SHALL
PROHIBIT A DULY REGISTERED LABORATORY FROM PROVIDING SERVICES, PROVIDED
SUCH LABORATORY AGREES TO PROVIDE SUCH SERVICES IN ACCORDANCE WITH THE
MINIMUM STANDARDS AND CONDITIONS FOR SIMILAR PROVIDERS THAT HAVE BEEN
ESTABLISHED BY SUCH GROUP OR BLANKET POLICY.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD07988-01-5
A. 4151 2
S 3. Section 4303 of the insurance law is amended by adding a new
subsection (pp) to read as follows:
(PP) NO SUCH POLICY ISSUED BY A THIRD PARTY BENEFIT PROGRAM SHALL
LIMIT OR DENY REIMBURSEMENT FOR BENEFITS TO ANY INSURED ON THE BASIS
THAT A LABORATORY PROVIDING CLINICAL LABORATORY SERVICES IS AN
OUT-OF-NETWORK PROVIDER, IF AN IN-NETWORK HEALTH CARE PROVIDER DIRECTS
SPECIMENS RETRIEVED BY SUCH HEALTH CARE PROVIDER TO SUCH OUT-OF-NETWORK
LABORATORY OR SUCH HEALTH CARE PROVIDER DIRECTS THE INSURED TO SUCH
OUT-OF-NETWORK LABORATORY FOR CLINICAL LABORATORY SERVICES. NO SUCH
THIRD PARTY BENEFIT PROGRAM SHALL PROHIBIT A DULY REGISTERED LABORATORY
FROM PROVIDING SERVICES, PROVIDED SUCH LABORATORY AGREES TO PROVIDE SUCH
SERVICES IN ACCORDANCE WITH THE MINIMUM STANDARDS AND CONDITIONS FOR
SIMILAR PROVIDERS THAT HAVE BEEN ESTABLISHED BY SUCH THIRD PARTY BENEFIT
PROGRAM.
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 all
policies and contracts issued, renewed, modified, altered or amended on
or after such effective date.