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This entry was published on 2014-09-22
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SECTION 4406-A
Arbitration provisions of health maintenance organization contracts
Public Health (PBH) CHAPTER 45, ARTICLE 44
§ 4406-a. Arbitration provisions of health maintenance organization
contracts. 1. The enrollee contract of a health maintenance organization
may permit enrollees and adult members of the enrollee's family who are
covered by such contract to elect to have all claims for damages because
of injury or death resulting from health care or treatment rendered or
failed to be rendered pursuant to the contract by a physician, dentist,
hospital, health maintenance organization or other health care provider
subject to binding arbitration, pursuant to article seventy-five-A of
the civil practice law and rules. For the purposes of this section,
"health maintenance organizations" shall include those health
maintenance organizations organized pursuant to this article or pursuant
to article forty-three of the insurance law. The enrollee contract may
permit arbitration elections to be executed on behalf of minor children
or persons judicially determined to be incompetent by a parent, legal
guardian, committee or conservator or other person legally authorized to
enroll the minor or incompetent person in a health maintenance
organization. Arbitration election notices, described in subdivisions
two and three of this section, must be executed by covered adult family
members in order to bind such persons to the arbitration election.

2. After receiving the approval of the superintendent of financial
services, pursuant to section five thousand six hundred five of the
insurance law, health maintenance organizations may provide arbitration
election notices to current enrollees and their covered adult family
members. Such notice shall contain the following provision in at least
twelve point boldface type immediately above spaces for the signature of
the enrollee or covered adult family member: "By signing this form, I am
agreeing to have any issue of alleged health care malpractice decided by
neutral arbitration rather than by a court trial before a judge or jury.
(Health care malpractice means claims for damages because of injury or
death resulting from health care or treatment rendered or failed to be
rendered pursuant to my health maintenance organization contract by the
health maintenance organization, a physician, dentist, hospital or other
health care provider.) I understand that I will be given the opportunity
to cancel my agreement, but that all claims arising during the time of
my agreement will be subject to arbitration. I understand that by
signing the form, I am deemed to have received and reviewed the
information describing arbitration that has been provided to me. I also
understand that there is no requirement that I sign this form and that
my decision not to sign this form will not in any way affect my
membership or benefits in this health maintenance organization."

3. After receiving the approval of the superintendent of financial
services, pursuant to section five thousand six hundred five of the
insurance law, health maintenance organizations may also provide
arbitration election notices, as specified in subdivision two of this
section, to new enrollees and their covered adult family members. In the
alternative, a health maintenance organization may, after receiving the
superintendent's approval, elect to provide an alternative notice to new
enrollees and their covered adult family members that provides that new
enrollees and their covered adult family members shall be subject to the
arbitration of claims unless a form is executed by such persons that
declines consent to the arbitration of claims. A health maintenance
organization that chooses to provide such alternative notice shall
provide an arbitration declination form and notice to all new enrollees
and their covered adult family members with the following provision in a
least twelve point boldface type immediately above spaces for the
signature of the enrollee or covered adult family member: "Unless you
sign this form to decline the option of arbitration, by electing to
enroll in this health maintenance organization, you are agreeing to have
any issue of health care malpractice decided by neutral arbitration
rather than by a court trial before a judge or jury. (Health care
malpractice means all claims for damages because of injury or death
resulting from health care or treatment rendered or failed to be
rendered pursuant to your health maintenance organization contract by
the health maintenance organization, a physician, dentist, hospital or
other health care provider.) If you do not sign this form to decline
arbitration, you will be given the opportunity to cancel your agreement
to arbitrate these claims, but all claims arising prior to the time that
you cancel the agreement will be subject to arbitration. You are
entitled to receive information describing arbitration before making
this decision. Your decision to sign this form to decline arbitration
will not in any way affect your membership or benefits in this health
maintenance organization."

4. Arbitration election notices may be provided, from time to time, by
health maintenance organizations to persons who have not agreed to
arbitration of such claims. The health maintenance organizations shall,
in a form and manner determined to be sufficient by the superintendent
of financial services and on at least an annual basis, provide notice to
persons who have agreed to arbitration of such claims that such persons
may cancel their agreement to arbitrate, including information as to how
such person may cancel the arbitration agreement; provided, however,
that the agreement to arbitrate shall remain in force during such
person's enrollment or membership in the health maintenance organization
unless the health maintenance organization receives notification of such
person's cancellation of the arbitration agreement or the health
maintenance organization withdraws its agreement to arbitrate and
provides notice of this fact to persons who elected arbitration.

5. Every such notice shall be accompanied by or be part of an
information brochure, prepared in accordance with section five thousand
six hundred four of the insurance law, which clearly explains the nature
and scope of arbitration and the procedures that will be used to conduct
these arbitration proceedings.

6. All claims arising from surgical, medical, dental and other health
care procedures performed or failed to be performed and treatment
provided or failed to be provided by a physician, dentist, hospital,
health maintenance organization or other health care provider pursuant
to the enrollee contract to an enrollee or a covered adult family member
who signs the arbitration election notice or who fails to sign the
arbitration declination form specified in subdivision three of this
section shall be subject to arbitration and such enrollees or covered
adult family members shall be bound by the agreement to arbitrate such
claims. All physicians, dentists, hospitals, health maintenance
organizations and other health care providers who provide or receive
compensation for health care services pursuant to the enrollee contract
shall be bound by the agreement to arbitrate.

7. Notwithstanding any inconsistent provisions of law, an agreement to
arbitrate which complies with the provisions of this section shall be
presumed valid.