Assembly Bill A6278

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6278
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               March 3, 2025
                                ___________
 
 Introduced by M. of A. STECK, SEAWRIGHT -- read once and referred to the
   Committee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to  electronic  notification  when  prior authorization is required to
   fill a prescription
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraphs 13 and 14 of subsection (b) of section 3217-a of
 the  insurance law, as added by section 2 of part H of chapter 60 of the
 laws of 2014, are amended and a new paragraph 15 is  added  to  read  as
 follows:
   (13)  disclose  whether  a health care provider scheduled to provide a
 health care service is an in-network provider; [and]
   (14) with respect to out-of-network coverage, disclose the approximate
 dollar amount that the insurer will pay for  a  specific  out-of-network
 health  care  service. The insurer shall also inform the insured through
 such disclosure that such approximation is not binding  on  the  insurer
 and  that  the approximate dollar amount that the insurer will pay for a
 specific out-of-network health care service may change[.]; AND
   (15) WHERE APPLICABLE, ALLOW  AN  INSURED  TO  REQUEST  AN  ELECTRONIC
 NOTIFICATION  WITHIN THIRTY DAYS WHEN PRIOR AUTHORIZATION IS REQUIRED TO
 FILL A PRESCRIPTION.
   § 2. Paragraphs 13 and 14 of subsection (b) of  section  4324  of  the
 insurance law, as added by section 9 of part H of chapter 60 of the laws
 of 2014, are amended and a new paragraph 15 is added to read as follows:
   (13)  disclose  whether  a health care provider scheduled to provide a
 health care service is an in-network provider; [and]
   (14) with respect to out-of-network coverage, disclose the approximate
 dollar amount that the corporation will pay for a  specific  out-of-net-
 work  health care service. The corporation shall also inform the insured
 through such disclosure that such approximation is not  binding  on  the

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10368-01-5
              

 A. 6278                             2
 
 corporation  and that the approximate dollar amount that the corporation
 will  pay  for  a  specific  out-of-network  health  care  service   may
 change[.]; AND
   (15)  WHERE  APPLICABLE,  ALLOW  AN  INSURED  TO REQUEST AN ELECTRONIC
 NOTIFICATION WITHIN THIRTY DAYS WHEN PRIOR AUTHORIZATION IS REQUIRED  TO
 FILL A PRESCRIPTION.
   §  3.  Paragraphs  (m) and (n) of subdivision 2 of section 4408 of the
 public health law, as added by section 19 of part H of chapter 60 of the
 laws of 2014, are amended and a new paragraph (o) is added  to  read  as
 follows:
   (m)  disclose  whether  a  health care provider scheduled to provide a
 health care service is an in-network provider; [and]
   (n) with respect to out-of-network coverage, disclose the  approximate
 dollar  amount  that  the health maintenance organization will pay for a
 specific out-of-network health  care  service.  The  health  maintenance
 organization  shall also inform an enrollee through such disclosure that
 such approximation is not binding on the health maintenance organization
 and that the approximate  dollar  amount  that  the  health  maintenance
 organization  will pay for a specific out-of-network health care service
 may change[.]; AND
   (O) WHERE APPLICABLE,  ALLOW  AN  INSURED  TO  REQUEST  AN  ELECTRONIC
 NOTIFICATION  WITHIN THIRTY DAYS WHEN PRIOR AUTHORIZATION IS REQUIRED TO
 FILL A PRESCRIPTION.
   § 4. This act shall take effect immediately.