Assembly Bill A5438

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5438
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 14, 2025
                                ___________
 
 Introduced by M. of A. WEPRIN -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the insurance law, in relation to establishing reporting
   requirements  for  out  of state entities not authorized to facilitate
   payment or reimbursement of health care costs

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  The insurance law is amended by adding a new section 3246
 to read as follows:
   § 3246. HEALTH CARE SHARE PLAN OR ARRANGEMENT REPORTING  REQUIREMENTS.
 1.    ANY ENTITY NOT AUTHORIZED BY THE SUPERINTENDENT TO OFFER INSURANCE
 IN THE STATE OF NEW YORK, WHO OFFERS OR  INTENDS  TO  OFFER  A  PLAN  OR
 ARRANGEMENT  TO FACILITATE PAYMENT OR REIMBURSEMENT OF HEALTH CARE COSTS
 FOR RESIDENTS OF NEW YORK, REGARDLESS  OF  DOMICILE,  SHALL  SUBMIT  THE
 FOLLOWING  INFORMATION TO THE SUPERINTENDENT BY OCTOBER FIRST, TWO THOU-
 SAND TWENTY-FIVE, AND ANNUALLY THEREAFTER BY MARCH FIRST:
   (A) PARTICIPANT INFORMATION, INCLUDING:
   (I) THE TOTAL NUMBER OF INDIVIDUAL AND HOUSEHOLD PARTICIPANTS  IN  THE
 STATE OF NEW YORK FOR THE PREVIOUS CALENDAR YEAR;
   (II)  THE TOTAL NUMBER OF EMPLOYER GROUPS PARTICIPATING, WITH SPECIFIC
 PARTICIPANT NUMBERS FOR EACH EMPLOYER GROUP; AND
   (III) THE TOTAL NUMBER OF NATIONAL PARTICIPANTS,  IF  OFFERED  OUTSIDE
 THE STATE OF NEW YORK.
   (B) PROVIDER CONTRACTS WHICH SHALL INCLUDE A LIST OF CONTACTS WITH NEW
 YORK-BASED PROVIDERS DELIVERING HEALTH CARE SERVICES TO PARTICIPANTS.
   (C) FINANCIAL AND OPERATIONAL INFORMATION, INCLUDING:
   (I)  THE  TOTAL  FEES, DUES, OR OTHER PAYMENTS COLLECTED FROM NEW YORK
 PARTICIPANTS IN THE PREVIOUS YEAR, SPECIFYING  THE  PERCENTAGE  RETAINED
 FOR ADMINISTRATIVE COSTS;
   (II)  THE DOLLAR AMOUNTS OF HEALTH CARE REIMBURSEMENT REQUESTS SUBMIT-
 TED AND PAID WITHIN NEW YORK FOR THE PRIOR CALENDAR YEAR;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07830-01-5
              

 A. 5438                             2
 
   (III) THE NUMBER OF REIMBURSEMENT REQUESTS DENIED, INCLUDING  PERCENT-
 AGES AND APPEALS DENIED; AND
   (IV) THE AMOUNT THE HEALTH CARE SHARING MINISTRY SPENT ON MEDICAL CARE
 VERSUS  ADMINISTRATION OVER THE PAST FIVE YEARS OF THE MINISTRY'S OPERA-
 TION.
   (D) DISCLOSURE OF COVERAGE AND EXCLUSIONS, INCLUDING:
   (I) A COMPREHENSIVE LIST OF ALL BENEFITS COVERED BY THE MINISTRY AND A
 DETAILED LIST OF ANY EXCLUDED HEALTH PROCEDURES, DRUGS, AND DEVICES;
   (II) A LIST OF ALL HEALTH CARE PROVIDERS, HOSPITALS,  HEALTH  CENTERS,
 DENTISTS,  LABORATORIES,  AND  PHARMACIES THAT PARTICIPATE IN THE HEALTH
 CARE SHARING MINISTRY;
   (III) A LIST OF ANY EXCLUDED HEALTH CONDITIONS, INCLUDING PRE-EXISTING
 CONDITIONS OR HIGHER FEES THAT MAY BE LEVIED DUE TO AN ENROLLEE'S EXIST-
 ING HEALTH CONDITION OR STATUS;
   (IV) A DESCRIPTION OF ANY WAITING PERIODS FOR ELIGIBILITY  FOR  HEALTH
 CARE SHARING MINISTRY PAYMENT; AND
   (V)  A  DESCRIPTION OF ANY ENROLLMENT ELIGIBILITY RULES OR CONDITIONS,
 SUCH AS AGE LIMITS OR REQUIREMENTS TO BE MARRIED.
   (E) OPERATIONAL AND MARKETING INFORMATION, INCLUDING:
   (I) A LIST OF COUNTIES IN NEW YORK WHERE PLANS  WERE  OFFERED  IN  THE
 PREVIOUS YEAR AND ARE PLANNED FOR THE FOLLOWING YEAR; AND
   (II)  DETAILS  OF  ANY  THIRD-PARTY  ENTITIES INVOLVED IN MARKETING OR
 ENROLLING PARTICIPANTS IN NEW YORK, INCLUDING COMMISSIONS OR FEES PAID.
   (F) ORGANIZATIONAL INFORMATION, INCLUDING:
   (I) NAMES, ADDRESSES, AND CONTACT INFORMATION FOR  KEY  ORGANIZATIONAL
 CONTACTS IN NEW YORK; AND
   (II) AN ORGANIZATIONAL CHART WITH OFFICER AND DIRECTOR DETAILS.
   2.  AN  OFFICER  OF AN ENTITY WHO OFFERS OR INTENDS TO OFFER A PLAN OR
 ARRANGEMENT TO FACILITATE PAYMENT OR REIMBURSEMENT OF HEALTH CARE  COSTS
 FOR  RESIDENTS OF NEW YORK SHALL CERTIFY THE INFORMATION REQUIRED PURSU-
 ANT TO SUBSECTION ONE OF THIS SECTION.
   3.  AN  ENTITY  THAT  FAILS  TO  PROVIDE  COMPLETE  INFORMATION   UPON
 SUBMISSION AS REQUIRED BY SUBSECTION ONE OF THIS SECTION SHALL HAVE SUCH
 SUBMISSION  DEEMED INCOMPLETE. THE SUPERINTENDENT SHALL NOTIFY AN ENTITY
 OF ANY DEFICIENCIES WITH SUCH ENTITIES SUBMISSION WITHIN FORTY-FIVE DAYS
 OF DEEMING A SUBMISSION INCOMPLETE. IF AN ENTITY FAILS TO  CORRECT  SUCH
 DEFICIENCY WITHIN THIRTY DAYS, A DAILY FINE OF FIVE THOUSAND DOLLARS MAY
 BE  IMPOSED,  WITH FURTHER PENALTIES FOR CONTINUED NON-COMPLIANCE AT THE
 DISCRETION OF THE SUPERINTENDENT, INCLUDING, BUT NOT LIMITED TO  ISSUING
 AN EMERGENCY CEASE-AND-DESIST ORDER.
   4.  THE  SUPERINTENDENT  SHALL  POST  AN  ANNUAL REPORT BY APRIL FIRST
 SUMMARIZING  SUBMISSIONS,  ALONG  WITH  CONSUMER  GUIDANCE   ON   FILING
 COMPLAINTS.
   5.  THE  SUPERINTENDENT SHALL ADOPT RULES AND REGULATIONS NECESSARY TO
 IMPLEMENT THE PROVISIONS OF THIS SECTION.
   § 2. This act shall take effect on the ninetieth day  after  it  shall
 have become a law. Effective immediately, the addition, amendment and/or
 repeal  of  any  rule  or regulation necessary for the implementation of
 this act on its effective date are authorized to be made  and  completed
 on or before such effective date.