S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2975
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 28, 2019
                                ___________
 
 Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
   Committee on Insurance
 
 AN ACT to amend the insurance  law,  in  relation  to  requiring  health
   insurers  to provide insureds and covered persons the option to assign
   the payment of emergency services  benefits  directly  to  an  out  of
   network health care provider

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subsection (c) of section 3241 of  the  insurance  law,  as
 added  by  section  6  of  part  H of chapter 60 of the laws of 2014, is
 amended to read as follows:
   (c) (1) When an insured or enrollee under a contract  or  policy  that
 provides  coverage  for  emergency services receives the services from a
 health care provider that does not participate in the  provider  network
 of  an  insurer, a corporation organized pursuant to article forty-three
 of this chapter, a municipal cooperative health benefit  plan  certified
 pursuant  to  article  forty-seven of this chapter, a health maintenance
 organization certified pursuant to  article  forty-four  of  the  public
 health  law, or a student health plan established or maintained pursuant
 to section one thousand one hundred twenty-four of this chapter ("health
 care plan"), the health care plan  shall  ensure  that  the  insured  or
 enrollee shall (A) incur no greater out-of-pocket costs for the emergen-
 cy  services  than  the  insured  or enrollee would have incurred with a
 health care provider that participates in the health care plan's provid-
 er network AND (B) PROVIDE THE INSURED OR ENROLLEE THE OPTION OF ASSIGN-
 ING THE PAYMENT OF ANY  BENEFITS  DUE  UNDER  SUCH  CONTRACT  OR  POLICY
 DIRECTLY  TO THE HEALTH CARE PROVIDER. WHENEVER, IN ANY HEALTH INSURANCE
 CLAIM FORM, AN INSURED OR ENROLLEE SPECIFICALLY AUTHORIZES  THE  PAYMENT
 OF  BENEFITS  DIRECTLY  TO  A HEALTH CARE PROVIDER, THE HEALTH CARE PLAN
 SHALL MAKE SUCH PAYMENT TO THE  HEALTH  CARE  PROVIDER.    (2)  For  the
 purpose of this section, "emergency services" shall have the meaning set
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD03577-01-9

 A. 2975                             2
 
 forth in subparagraph (D) of paragraph nine of subsection (i) of section
 three  thousand two hundred sixteen of this article, subparagraph (D) of
 paragraph four of subsection (k) of section three thousand  two  hundred
 twenty-one  of  this  article,  and subparagraph (D) of paragraph two of
 subsection (a) of section four thousand  three  hundred  three  of  this
 chapter.
   §  2.  This  act shall take effect on the ninetieth day after it shall
 have become a law.