NY State Senate Bill 2025-S8124

Senate Bill S8124

2025-2026 Legislative Session

Relates to circumstances under which a consumer may be subject to a new special open enrollment period to choose a new health insurance plan

download bill text pdf

Current Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 15, 2025	referred to insurance

2025-S8124 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3217 & 4306, Ins L

2025-S8124 (ACTIVE) - Summary

Allows for a new special open enrollment period to choose a new health insurance plan for consumers in certain instances to allow for continuity of care with an existing health care provider.

2025-S8124 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S8124

SPONSOR: ASHBY
 
TITLE OF BILL:

An act to amend the insurance law, in relation to circumstances under
which a consumer may be subject to a new special open enrollment period
to choose a new health insurance plan

 
PURPOSE:

To allow consumers the opportunity of a "qualifying life event" if their
provider went out of network due to a contractual dispute between the
provider and insurer.

 
SUMMARY OF PROVISIONS:

Section 1 amends section 3217 of the insurance law by adding
paragraph(6), which provides that if a contract is severed with one or
more of a consumer's existing health care providers upon no fault of
such consumer, then a new special open enrollment period shall commence
to allow such consumer an opportunity to choose a new health insurance

plan that may allow for continuity of care with an existing health care
provider; provided that such health insurance policy or contract shall
not impose a fee or other penalty for special enrollment of such consum-
er; and provided further that upon enrollment, coverage shall be effec-
tive no later than 14 days after such consumer purchases the new health
insurance policy.

Section 2 amends section 4306 of the insurance law by adding new section
(p) that states that all contracts made must state in writing that if a
contract is severed upon no fault of the consumer, that a special open
enrollment period shall be allowed pursuant to paragraph 6 of subsection
(b) of section 3217.

 
JUSTIFICATION:

Consumers can only change medical insurance during either end-of-year
enrollment periods or at the time of "qualifying life events" such as
pregnancy, divorce or a job change. On the flip side, insurers'
contracts with doctors, hospitals and pharmaceutical companies can
change abruptly due to contract disputes.

In 2024, the Capital Region experienced multiple months-long insurer and
provider disputes that left the healthcare of tens of thousands of
consumers in limbo. If an insurer-provider contract lapsed there were
some patients who would have been eligible for continuity of care such
as women who were pregnant or were post-partum or those persons diag-
nosed with cancer or actively receiving cancer treatment. However, that
same solace of maintaining your preferred provider is not extended in
those circumstances to thousands of other consumers undergoing other
types of care. Elected officials throughout the Capital Region fielded
numerous constituent concerns during those disputes. In one instance
while the provider and insurer battled in the newspapers, a person
seeing a heart specialist was forced to agonize for weeks over whether
to switch providers or to pay out-of-pocket should their insurer drop
their specialist from their network.Eò


This bill would allow consumers the opportunity of a "qualifying life
event" if their provider went out of network due to a contractual
dispute between the provider and insurer. Consumers would be able to go
back to the healthcare marketplace to select insurance that their
preferred provider offers for continuity of care. It is unfair to the
consumer that after they select a healthcare plan for the calendar year
that their providers could be dropped mid-year. This bill would offer
the consumer a remedy to situations outside of their control and allow
access to the healthcare of their choice.

 
LEGISLATIVE HISTORY:

New

 
FISCAL IMPLICATIONS:

To be determined.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2025-S8124 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8124
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                               May 15, 2025
                                ___________
 
 Introduced  by  Sen.  ASHBY  -- read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law, in relation  to  circumstances  under
   which a consumer may be subject to a new special open enrollment peri-
   od to choose a new health insurance plan

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraphs 4 and 5 of subsection (b) of section 3217 of the
 insurance law are amended and a new paragraph 6  is  added  to  read  as
 follows:
   (4) elimination of provisions which may be contrary to the health care
 needs  of  the public, as certified to the superintendent by the commis-
 sioner of health; [and]
   (5) elimination of coverages which are so limited in scope as to be of
 no substantial economic value to the holders[.]; AND
   (6) PROVISION OF REASONABLE CIRCUMSTANCES UNDER WHICH, IF  A  CONTRACT
 IS SEVERED WITH ONE OR MORE OF A CONSUMER'S EXISTING HEALTH CARE PROVID-
 ERS  UPON  NO FAULT OF SUCH CONSUMER, THEN A NEW SPECIAL OPEN ENROLLMENT
 PERIOD SHALL COMMENCE TO ALLOW SUCH CONSUMER AN OPPORTUNITY TO CHOOSE  A
 NEW  HEALTH INSURANCE PLAN THAT MAY ALLOW FOR CONTINUITY OF CARE WITH AN
 EXISTING HEALTH CARE PROVIDER; PROVIDED THAT SUCH HEALTH INSURANCE POLI-
 CY OR CONTRACT SHALL NOT IMPOSE A  FEE  OR  OTHER  PENALTY  FOR  SPECIAL
 ENROLLMENT  OF SUCH CONSUMER; AND PROVIDED FURTHER THAT UPON ENROLLMENT,
 COVERAGE SHALL BE EFFECTIVE NO  LATER  THAN  FOURTEEN  DAYS  AFTER  SUCH
 CONSUMER PURCHASES SUCH NEW HEALTH INSURANCE POLICY.
   §  2.  Subsections (l), (m), (n) and (o) of section 4306 of the insur-
 ance law, subsection (n) as added by chapter 237 of the laws of 2009 and
 subsection (o) as amended by chapter 29 of the laws of 2023, are amended
 and a new subsection (p) is added to read as follows:

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD13120-01-5
 S. 8124                             2

   (l) if the contract contains any  provision  purporting  to  make  any
 portion  of  the  articles, constitution or by-laws of the corporation a
 part of the contract, such portion shall be set forth in full; [and]
   (m)  in  every  such  contract made, issued or delivered in this state
 there shall be a brief description of the contract on its first page and
 on its filing back[.];
   (n) a statement that a health care claim from a  subscriber  shall  be
 submitted  within  one  hundred  twenty  days  from the date of service;
 provided, however, that if  it  was  not  reasonably  possible  for  the
 subscriber  to  submit  the  claim within that timeframe, then the claim
 shall be submitted as soon as reasonably possible[.];
   (o) Space shall be provided on  any  enrollment,  renewal  or  initial
 online  portal process setup forms required of a subscriber or applicant
 for coverage, except forms issued by the NY State of Health,  the  offi-
 cial  Health  Plan Marketplace, other than those specifically referenced
 in subparagraph (iv) of paragraph (a) of  subdivision  five  of  section
 forty  three hundred ten and paragraph (v) of subdivision one of section
 two hundred six of the public health law,  so  that  the  subscriber  or
 applicant  for  coverage  shall  register or decline registration in the
 donate life registry for organ, eye  and  tissue  donations  under  this
 section  of  the  enrollment,  renewal  or initial online portal process
 setup forms and that the following is stated on the form  in  clear  and
 conspicuous type:
   "You  must  fill out the following section: Would you like to be added
 to the Donate Life Registry? Check box for 'yes'  or  'skip  this  ques-
 tion'."; AND
   (P)  A  STATEMENT  THAT  IF A CONTRACT IS SEVERED UPON NO FAULT OF THE
 CONSUMER, THAT A SPECIAL OPEN ENROLLMENT PERIOD SHALL BE ALLOWED  PURSU-
 ANT  TO  PARAGRAPH  SIX  OF SUBSECTION (B) OF SECTION THIRTY-TWO HUNDRED
 SEVENTEEN OF THIS CHAPTER.
   § 3. This act shall take effect immediately; provided,  however,  that
 if  chapter  29  of  the  laws of 2023 shall not have taken effect on or
 before such date then the amendments to subsection (o) of  section  4306
 of  the  insurance law made by section two of this act shall take effect
 on the same date and in the same manner as such chapter of the  laws  of
 2023, takes effect.

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