S T A T E O F N E W Y O R K
________________________________________________________________________
866
2021-2022 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 6, 2021
___________
Introduced by M. of A. GOTTFRIED, SAYEGH -- 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
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00248-01-1
A. 866 2
purpose of this section, "emergency services" shall have the meaning set
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.