Senate Bill S1960

                                 BILL NUMBER:  S1960

 TITLE OF BILL :

An act to amend the insurance law, in relation to requiring insurance
companies to disclose claims information to municipalities

 PURPOSE OR GENERAL IDEA OF BILL :

This bill allows the different levels of government employing 400 or
more workers an opportunity to assess accurately the true needs of
their employees when addressing health care benefits. It will create
transparency allowing these governments to negotiate more effectively
with all insurance companies that are bidding on future contracts.

 SUMMARY OF SPECIFIC PROVISIONS :

Section 1. Amends the insurance law by adding a new section 3217-i to
read as follows:

§ 3217-i Disclosure of information, to municipalities. (a) Every
insurer contracting with municipalities, including cooperative health
benefit plans certified.pursuant to article forty-seven of this
chapter shall provide upon request the following information to the
insured municipality.

              

1. Specific claims information must be furnished by the insurer under
community rated or experience rated policies;

2. Average annual per member cost of claims reimbursement;

3. Number of members that did not file a claim within a 12 month
period;

4. A comparison of emergency services used by members to out-patient
services; and

5. Provide municipality with loss ratio report

6. Claims history for the last 12 months must be provided for
experience rated plans separated by medical and prescription.

7. Information regarding cost on to 25 prescription drug being used by
member employees.

8. Large loss claims report indicating diagnosis and prognosis for
claims greater than $30,000.00.

9. Medical loss ratio report.

10. Any other statistical information the municipality requests to
determine use of benefits by members.

B. The superintendent shall impose a fine of three hundred thousand
dollars for failure to provide within thirty days of a written request
by the insured municipality the information required by paragraph one
of subsection (a) of this section regarding the insured employees. A
fine of ten thousand dollars a day will be imposed for every day such
failure continues; any fines imposed shall be paid directly to the
municipality requesting such information.

C. All information being released shall be done so in compliance with
the federal health insurance portability and accountability act
(HIPAA) of 1996.

Definition
The experience ratings will include all quantitative measures used by
the insurance company such as expenses per member, data supporting
said expenses and any historical data that will help determine the
risk of future claims. This information will provide transparency for
purposes of negotiations in future contracts.

 EXISTING LAW :

Article 32, subdivision 1 of section 3217 of Insurance Law is amended
to include a subsection 3217-G as listed above.

 JUSTIFICATION :

Every year villages, towns, cities and counties in New York State are
forced to put in place a budget that best meets the needs of those
governments. It is necessary for those creating budgets to have access
to accurate numbers that reflect a true need.  Without under standing
how well health care programs are being utilized, it is very difficult
to negotiate in good faith with insurance carriers. Large insurance
carriers will continue to have an unfair advantage over governments
until transparencies exist and negotiations reflect actual cost.

 PRIOR LEGISLATIVE HISTORY :

2009-10 - A.9130-B (Latimer) Referred to Insurance
2011-12 - A.101 (Latimer) Referred to Insurance
2009-10 - S.7560 (Parker) Referred to Insurance
2011-12 - S.1120 (Parker) Referred to Insurance
2013-14 - A.2056 (Latimer) REFERRED TO INSURANCE
2013-14 A.7219 (Zebrowski) Referred to Insurance
2015-16- S.1185 (Latimer) REFERRED TO INSURANCE

 FISCAL IMPLICATIONS :

None to New York State LOCAL

 FISCAL IMPLICATIONS :

To be determined

 EFFECTIVE DATE :
This act will take effect immediately.