S T A T E O F N E W Y O R K
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2867
2019-2020 Regular Sessions
I N A S S E M B L Y
January 28, 2019
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Introduced by M. of A. ZEBROWSKI -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law, in relation to requiring medical
insurers to permit patients to assign their payment
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 35 to read as follows:
(35) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR-MEDICAL OR SIMILAR
COMPREHENSIVE-TYPE COVERAGE SHALL PERMIT A PATIENT TO ASSIGN HIS OR HER
PAYMENT TO THE PROVIDER OF SUCH HOSPITAL, SURGICAL OR MEDICAL SERVICES,
REGARDLESS OF WHETHER THE PROVIDER IS IN THE NETWORK OF HEALTH CARE
PROVIDERS OFFERED BY THE INSURER ISSUING THE POLICY, PROVIDED THAT THE
SERVICES RENDERED TO THE PATIENT BY THE PROVIDER ARE OTHERWISE COVERED
UNDER THE POLICY.
§ 2. Section 3221 of the insurance law is amended by adding a new
subsection (t) to read as follows:
(T) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY IN
THIS STATE WHICH PROVIDES HOSPITAL, SURGICAL OR MEDICAL COVERAGE SHALL
PERMIT A PATIENT TO ASSIGN HIS OR HER PAYMENT TO THE PROVIDER OF SUCH
HOSPITAL, SURGICAL OR MEDICAL SERVICES, REGARDLESS OF WHETHER THE
PROVIDER IS IN THE NETWORK OF HEALTH CARE PROVIDERS OFFERED BY THE
INSURER ISSUING THE POLICY, PROVIDED THAT THE SERVICES RENDERED TO THE
PATIENT BY THE PROVIDER ARE OTHERWISE COVERED UNDER THE POLICY.
§ 3. Section 3224-a of the insurance law is amended by adding a new
subsection (k) to read as follows:
(K) WHERE PAYMENT FOR ANY PORTION OF A CLAIM IS MADE DIRECTLY TO A
HEALTH CARE PROVIDER, SUCH INSURER OR ORGANIZATION OR CORPORATION SHALL
PROVIDE AT THE TIME PAYMENT IS MADE WRITTEN NOTIFICATION OF SUCH PAYMENT
TO THE POLICYHOLDER WHO RENDERED THE SERVICE FOR WHICH THE CLAIM WAS
PAID. SUCH NOTIFICATION SHALL INCLUDE, BUT NOT BE LIMITED TO, THE AMOUNT
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02142-01-9
A. 2867 2
PAID TO THE HEALTH CARE PROVIDER, THE PERCENTAGE OF THE TOTAL CLAIM
REPRESENTED BY THE PAYMENT, THE SERVICES FOR WHICH PAYMENT WAS MADE, THE
HEALTH CARE PROVIDER PROVIDING THOSE SERVICES AND THE CALCULATIONS FOR
PAYMENT, BY SERVICE PROVIDED, INCLUDING CO-PAYMENTS, DEDUCTIBLES,
SURCHARGES AND FEE SCHEDULES.
§ 4. Section 4303 of the insurance law is amended by adding a new
subsection (a-1) to read as follows:
(A-1) EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION
OR HEALTH SERVICE CORPORATION WHICH PROVIDES MEDICAL, MAJOR MEDICAL OR
SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PERMIT A PATIENT TO ASSIGN HIS
OR HER BENEFITS TO THE PROVIDER OF SUCH HOSPITAL, SURGICAL OR MEDICAL
SERVICES, REGARDLESS OF WHETHER THE PROVIDER IS IN THE NETWORK OF HEALTH
CARE PROVIDERS OFFERED BY THE INSURER ISSUING THE POLICY, PROVIDED THAT
THE SERVICES RENDERED TO THE PATIENT BY THE PROVIDER ARE OTHERWISE
COVERED UNDER THE POLICY.
§ 5. This act shall take effect on the ninetieth day after it shall
have become a law and shall apply to policies and contracts issued,
renewed, modified, altered or amended on or after such date.