Bill Text: NY A00598 | 2019-2020 | General Assembly | Introduced

---

Bill Title: Requires health insurers to offer coverage of health care provided by out-of-network providers.

Spectrum: Moderate Partisan Bill (Democrat 9-1)

Status: (Introduced - Dead) 2020-01-08 - referred to insurance [A00598 Detail]

Download: New_York-2019-A00598-Introduced.html

---

                STATE OF NEW YORK
        ________________________________________________________________________
                                           598
                               2019-2020 Regular Sessions
                   IN ASSEMBLY
                                       (Prefiled)
                                     January 9, 2019
                                       ___________
        Introduced  by  M. of A. L. ROSENTHAL, JAFFEE, STECK, FAHY, JEAN-PIERRE,
          HEVESI, TAYLOR, MONTESANO -- Multi-Sponsored by -- M. of  A.  EPSTEIN,
          SIMON -- read once and referred to the Committee on Insurance
        AN ACT to amend the public health law and the insurance law, in relation
          to  requiring  health  care insurers to offer coverage for health care
          provided by out-of-network providers
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
     1    Section 1.  Section 4403 of the public health law is amended by adding
     2  a new subdivision 9 to read as follows:
     3    9.  Every  health  maintenance organization shall offer out-of-network
     4  coverage as an optional rider to any contract and shall offer  at  least
     5  one contract option that includes out-of-network coverage. These options
     6  shall  be  made  available  both  within  the  statewide  health benefit
     7  exchange and outside of the health benefit exchange.
     8    § 2. Section 3217-e of the insurance law, as added by chapter  219  of
     9  the laws of 2011, is amended to read as follows:
    10    §  3217-e.  Choice  of  health  care  provider. (a) An insurer that is
    11  subject to this article and requires or provides for designation  by  an
    12  insured  of  a  participating  primary  care  provider  shall permit the
    13  insured to designate any participating  primary  care  provider  who  is
    14  available  to  accept such individual, and in the case of a child, shall
    15  permit the insured to designate a physician (allopathic or  osteopathic)
    16  who  specializes  in  pediatrics as the child's primary care provider if
    17  such provider participates in the network of the insurer.
    18    (b) Every insurer that offers health insurance and is subject  to  the
    19  provisions  of  this  article, shall offer out-of-network coverage as an
    20  optional rider to any policy and shall offer at least one policy  option
    21  that  includes  out-of-network  coverage.  These  options  shall be made
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04689-01-9
        A. 598                              2
     1  available both within the statewide health benefit exchange and  outside
     2  of the health benefit exchange.
     3    §  3.  Section 4306-d of the insurance law, as added by chapter 219 of
     4  the laws of 2011, is amended to read as follows:
     5    § 4306-d. Choice of health care provider. (a) A  corporation  that  is
     6  subject  to  the provisions of this article and requires or provides for
     7  designation by a subscriber of a  participating  primary  care  provider
     8  shall  permit the subscriber to designate any participating primary care
     9  provider who is available to accept such individual, and in the case  of
    10  a child, shall permit the subscriber to designate a physician (allopath-
    11  ic  or osteopathic) who specializes in pediatrics as the child's primary
    12  care provider if such provider participates in the network of the corpo-
    13  ration.
    14    (b) Every corporation that is subject to the provisions of this  arti-
    15  cle,  shall  offer  out-of-network  coverage as an optional rider to any
    16  contract and shall offer at least  one  contract  option  that  includes
    17  out-of-network  coverage.  These  options  shall  be made available both
    18  within the statewide health benefit exchange and outside of  the  health
    19  benefit exchange.
    20    §  4. This act shall take effect on the first of January next succeed-
    21  ing the date on which it shall have become a law,  and  shall  apply  to
    22  contracts  and policies issued, renewed, modified or amended on or after
    23  such date.