NY State Senate Bill 2015-S7370

Senate Bill S7370

2015-2016 Legislative Session

Requires health insurers to provide health care providers with the coverage a policyholder or covered person has, when liability is unclear

download bill text pdf

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Apr 22, 2016	referred to insurance

2015-S7370 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §3224-a, Ins L
Versions Introduced in Other Legislative Sessions:: 2017-2018: S5779
2019-2020: S6341

2015-S7370 (ACTIVE) - Summary

Requires health insurers to provide health care providers with the coverage a policyholder or covered person has, when liability for a health care claim is not reasonably clear.

2015-S7370 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S7370

 TITLE OF BILL :  An act to amend the insurance law, in relation to
requiring health insurers to provide, when liability for a claim is
not reasonably clear, the coverage the policyholder or covered person
is enrolled in

 PURPOSE :

The require plans to clearly identify to a provider the product an
individual is enrolled in for health coverage purposes.

 SUMMARY OF PROVISIONS :

Section 1 amends subsection (b) of section 3224-a of the Insurance Law
to add a new requirement that an insurer identify the specific type of
plan or product the policy-holder or covered person is enrolled in.

Section 2 amends subsection (d) of section 3224-a of the Insurance law
to define the plans or products that must be identified by the
insurer.

Section 3 provides that this act shall take effect July 1, 2017.

 JUSTIFICATION :

Hospitals and health care providers are currently challenged with
identifying which specific health plan a patient is enrolled in.
Health plans today offer a wide variety of products, which can make it
very difficult to identify what particular health coverage a patient
has. There is no requirement for plans to consistently and uniformly
identify what particular product an individual in enrolled in.

The current inability to identify these products or the regulatory
rules that apply causes providers, regulators, and plans to waste
valuable resources appealing, communicating, and replacing claims
incorrectly or when it is not necessary. Under the current system,
identification of the type of coverage is ultimately made after an
appeal is submitted by a patient or a provider and after these
resources have already been wasted.

This bill would ensure plans provide necessary at the time the plan
makes a payment determination. This will avoid wasting time and energy
on filing unnecessary appeals and identify protections available for
patients based on their particular coverage by ensuring clear and
consistent information about the particular product a patient is
enrolled in.

 LEGISLATIVE HISTORY :

New Bill

 FISCAL IMPLICATIONS :

None

 EFFECTIVE DATE :
July 1, 2017

2015-S7370 (ACTIVE) - Bill Text download pdf

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

                                  7370

                            I N  S E N A T E

                             April 22, 2016
                               ___________

Introduced  by  Sen.  HANNON -- 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  requiring  health
  insurers  to  provide,  when  liability  for a claim is not reasonably
  clear, the coverage the policyholder or covered person is enrolled in

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

  Section  1.  Paragraph  2  of  subsection (b) of section 3224-a of the
insurance law, as amended by chapter 237 of the laws of 2009, is amended
and a new paragraph 3 is added to read as follows:
  (2) to request all additional information needed to determine  liabil-
ity to pay the claim or make the health care payment[.]; AND
  (3)  OF  THE  SPECIFIC  TYPE  OF  PLAN  OR PRODUCT THE POLICYHOLDER OR
COVERED PERSON IS ENROLLED IN.
  S 2. Subsection (d) of section 3224-a of the insurance law is  amended
by adding a new paragraph 3 to read as follows:
  (3) "PLAN OR PRODUCT" SHALL MEAN:
  (I)  MEDICAID  COVERAGE  CERTIFIED  PURSUANT  TO SECTION THREE HUNDRED
SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW;
  (II) A CHILD HEALTH INSURANCE PLAN CERTIFIED PURSUANT TO SECTION TWEN-
TY-FIVE HUNDRED ELEVEN OF THE PUBLIC HEALTH LAW;
  (III) BASIC HEALTH PROGRAM  COVERAGE  CERTIFIED  PURSUANT  TO  SECTION
THREE  HUNDRED  SIXTY-NINE-GG  OF THE SOCIAL SERVICES LAW, INCLUDING THE
SPECIFIC RATING GROUP THE POLICYHOLDER OR COVERED PERSON IS ENROLLED IN;
  (IV) COVERAGE PURCHASED ON THE NEW YORK INSURANCE EXCHANGE ESTABLISHED
PURSUANT TO ARTICLE SIXTY-TWO OF THIS CHAPTER; AND
  (V) ANY OTHER PRODUCT FULLY INSURED AND REGULATED BY THE  STATE  UNDER
ARTICLE FORTY-TWO, FORTY-THREE, OR FORTY-SEVEN OF THIS CHAPTER, OR ARTI-
CLE FORTY-FOUR OF THE PUBLIC HEALTH LAW.
  S 3. This act shall take effect July 1, 2017.


 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD15055-02-6

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