S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1151
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              January 7, 2021
                                ___________
 
 Introduced  by  M. of A. L. ROSENTHAL, STECK, FAHY, JEAN-PIERRE, HEVESI,
   TAYLOR, MONTESANO -- Multi-Sponsored by -- M. of A. EPSTEIN, SIMON  --
   read once and referred to the Committee on Insurance
 
 AN ACT to amend the public health law and the insurance 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 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.
   § 2. 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.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD00768-01-1

 A. 1151                             2
 
   §  3.  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
 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.
   § 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.