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This entry was published on 2014-09-22
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Review of health maintenance organization arbitration experience
Insurance (ISC) CHAPTER 28, ARTICLE 56
§ 5605. Review of health maintenance organization arbitration
experience. No health maintenance organization shall offer enrollees the
option of electing arbitration of claims pursuant to section forty-four
hundred six-a of the public health law without notifying the
superintendent of an intention to offer the arbitration option and
obtaining the superintendent's approval. The superintendent shall
approve such requests, subject to the limitations of this section and in
a manner that allows for sufficient geographical and program diversity
to permit an effective evaluation of the arbitration experience. The
superintendent of financial services shall require health maintenance
organizations to submit, on a quarterly basis, information concerning
the numbers of enrollees who elect the arbitration option, along with
such other information as the superintendent may require.
Notwithstanding the provisions of section forty-four hundred six-a of
the public health law, no health maintenance organization shall permit
new enrollees to elect the arbitration of claims after December first,
nineteen hundred ninety-one or after such organizations have been
notified by the superintendent that five hundred thousand persons have
elected to arbitrate claims, whichever event first occurs. Within one
hundred twenty days of such date or event, the superintendent shall
submit a report to the governor and the legislature describing the
experience of health maintenance organization enrollee arbitration and
including any recommendations for the future of such program.