S T A T E O F N E W Y O R K ________________________________________________________________________ 3505 2013-2014 Regular Sessions I N A S S E M B L Y January 28, 2013 ___________ Introduced by M. of A. PRETLOW -- read once and referred to the Commit- tee on Insurance AN ACT to amend the insurance law, in relation to notice by health main- tenance organizations that a request for coverage of a particular treatment is denied THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. The insurance law is amended by adding a new section 2601-a 2 to read as follows: 3 S 2601-A. DENIAL OF COVERAGE OR TREATMENT BY A HEALTH MAINTENANCE 4 ORGANIZATION. WHENEVER A HEALTH MAINTENANCE ORGANIZATION, DOING BUSINESS 5 IN THIS STATE, DENIES A CLAIM FOR COVERAGE OF A PARTICULAR PROCEDURE OR 6 TREATMENT BECAUSE SUCH PROCEDURE OR TREATMENT IS NOT MEDICALLY NECES- 7 SARY, THE HEALTH MAINTENANCE ORGANIZATION SHALL INFORM THE INSURED AS TO 8 THOSE PREFERRED PROCEDURE OR TREATMENT OPTIONS WHICH WOULD BE COVERED, 9 OR PROVIDE THE INSURED WITH A STATEMENT AS TO THE PAST INEFFECTIVENESS 10 OF THE REQUESTED PROCEDURE OR TREATMENT. 11 S 2. This act shall take effect on the thirtieth day after it shall 12 have become a law. EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD07569-01-3