S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    434
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              January 9, 2017
                                ___________
 
 Introduced  by  M.  of  A. ROSENTHAL, THIELE, GALEF, SKOUFIS, SEPULVEDA,
   STECK, ZEBROWSKI -- Multi-Sponsored by -- M. of A.  LUPINACCI,  SIMON,
   SKARTADOS -- 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:
   § 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.
   § 2. Section 4306-d of the insurance law, as added by chapter  219  of
 the laws of 2011, is amended to read as follows:
   §  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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD01720-01-7

 A. 434                              2
 
 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.
   (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.
   § 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.
   § 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.