S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7055
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               May 10, 2023
                                ___________
 
 Introduced  by  M. of A. McDONALD, FALL -- read once and referred to the
   Committee on Governmental Employees
 
 AN ACT to amend the civil service law, in relation  to  clarifying  that
   the New York state health insurance program remains subject to certain
   provisions of the financial services law

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (iv) of paragraph  (b)  of  subdivision  1  of
 section 162 of the  civil service law, as amended by section 3 of part T
 of  chapter 56 of the laws of 2010 and as further amended by section 104
 of part A of chapter 62 of the laws of  2011,  is  amended  to  read  as
 follows:
   (iv)  Notwithstanding  the  provisions of this subdivision, the presi-
 dent's election to provide health benefits directly to plan participants
 shall not constitute the doing of insurance business within the  meaning
 of  article eleven of the insurance law; provided however, the provision
 of direct benefits as per this subdivision shall be subject to review by
 the superintendent of financial services for the  purposes  of  ensuring
 compliance  with  applicable  insurance  law  and any and all associated
 insurance rules and regulations as noted in this subdivision.   FURTHER,
 THE PROVISION OF DIRECT BENEFITS AS PER THIS SUBDIVISION, AND ANY ENTITY
 PROVIDING  ADMINISTRATIVE  SERVICES  REGARDING  THOSE BENEFITS, SHALL BE
 SUBJECT TO THE JURISDICTION OF THE DEPARTMENT OF FINANCIAL  SERVICES  IN
 ACCORDANCE  WITH ARTICLE THREE OF THE FINANCIAL SERVICES LAW, AS WELL AS
 THE PROVISIONS OF ARTICLE SIX OF THE FINANCIAL SERVICES LAW.
   § 2. Subparagraph (i) of paragraph (b) of subdivision 1 of section 162
 of the civil service law, as amended by section 3 of part T  of  chapter
 56 of the laws of 2010, is amended to read as follows:
   (i) Any and all health insurance coverage mandated by any law, rule or
 regulation,  including  but not limited to coverage mandated pursuant to
 article forty-three of the insurance law, applicable  to  contracts  for
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09746-03-3
              

 A. 7055                             2
 
 health  insurance entered into under this section shall be provided in a
 manner assuring uninterrupted continuance of coverage  for  all  covered
 persons. HEALTH BENEFITS SHALL INCLUDE A REQUIREMENT THAT COVERED HEALTH
 CARE  SERVICES  PROVIDED  TO PLAN PARTICIPANTS WILL BE REIMBURSED AT THE
 LEVEL OF AT LEAST EIGHTY PERCENT OF THE USUAL AND CUSTOMARY COST OF EACH
 OUT-OF-NETWORK HEALTH   CARE SERVICE.  AS  USED  IN  THIS  SUBPARAGRAPH,
 "USUAL  AND  CUSTOMARY  COST" SHALL MEAN THE EIGHTIETH PERCENTILE OF ALL
 CHARGES FOR THE PARTICULAR HEALTH CARE SERVICE PERFORMED BY  A  PROVIDER
 IN  THE  SAME OR SIMILAR SPECIALTY AND PROVIDED IN THE SAME GEOGRAPHICAL
 AREA AS REPORTED IN A BENCHMARKING DATABASE MAINTAINED  BY  A  NONPROFIT
 ORGANIZATION  SPECIFIED BY THE SUPERINTENDENT OF FINANCIAL SERVICES. For
 the purposes of this paragraph "coverage" shall include but shall not be
 limited to all benefits, services,  rights,  privileges  and  guarantees
 allowed by law;
   §  3.  Subdivision  1  of  section  161-a of the civil service law, as
 amended by section 10 of part T of chapter 56 of the laws  of  2010,  is
 amended to read as follows:
   1.  Where,  and to the extent that, an agreement between the state and
 an employee organization entered into pursuant to  article  fourteen  of
 this  chapter provides for health benefits, the president, after receipt
 of written directions from the director  of  employee  relations,  shall
 implement  the  provisions  of  such agreement consistent with the terms
 thereof and to the extent necessary shall  adopt  regulations  providing
 for  the  benefits  to  be  thereunder provided. The president, with the
 approval of the director of the budget, may  extend  such  benefits,  in
 whole  or in part, PROVIDED THAT SUCH BENEFITS ARE NOT A DIMINISHMENT OF
 CURRENT EXISTING BENEFITS to employees not subject to the provisions  of
 such agreement.
   § 4. This act shall take effect immediately.