Bill Text: NY S00166 | 2011-2012 | General Assembly | Introduced
Bill Title: Provides that health insurers may not deny reimbursements to insureds because the registered pharmacy providing pharmaceutical products has not been approved by the insurer or other entity.
Sponsorship: Moderate Partisan Bill (Republican 4-1)
Status: (Introduced - Dead) 2012-01-18 - PRINT NUMBER 166A [S00166 Detail]
Download: New_York-2011-S00166-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
166
2011-2012 Regular Sessions
I N S E N A T E
(PREFILED)
January 5, 2011
___________
Introduced by Sens. MAZIARZ, GOLDEN, LITTLE -- read twice and ordered
printed, and when printed to be committed to the Committee on Insur-
ance
AN ACT to amend the insurance law, in relation to health insurance
coverage and to eligibility for employee benefits provided by employee
welfare funds
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Subsection (i) of section 3216 of the insurance law is
2 amended by adding a new paragraph 28 to read as follows:
3 (28) NO SUCH POLICY SHALL LIMIT BENEFITS OR DENY REIMBURSEMENT FOR
4 BENEFITS TO ANY INSURED ON THE BASIS THAT THE PHARMACY PROVIDING SUCH
5 BENEFITS HAS NOT BEEN SPECIFICALLY SELECTED OR APPROVED. IF THE INSURED,
6 HIS DEPENDENTS OR BOTH RECEIVE SERVICES FROM A PHARMACY OF THEIR OWN
7 CHOOSING, SUCH INSURED SHALL PAY THE COST OF SUCH PHARMACEUTICAL
8 PRODUCTS TO THE EXTENT THAT SUCH COST EXCEEDS THE BENEFITS PROVIDED
9 UNDER THE POLICY WITHOUT FORFEITURE OF THE BENEFITS PROVIDED UNDER SUCH
10 POLICY. NO SUCH POLICY SHALL PROHIBIT A DULY REGISTERED PHARMACY FROM
11 PROVIDING SERVICES, PROVIDED SUCH PHARMACY AGREES TO PROVIDE SUCH
12 SERVICES IN ACCORDANCE WITH THE MINIMUM STANDARDS AND CONDITIONS FOR
13 SIMILAR PROVIDERS THAT HAVE BEEN ESTABLISHED BY SUCH POLICY.
14 S 2. Subsection (e) of section 3221 of the insurance law is amended by
15 adding a new paragraph 12 to read as follows:
16 (12) NO SUCH GROUP OR BLANKET POLICY SHALL LIMIT BENEFITS OR DENY
17 REIMBURSEMENT FOR BENEFITS TO ANY INSURED ON THE BASIS THAT THE PHARMACY
18 PROVIDING SUCH BENEFITS HAS NOT BEEN SPECIFICALLY SELECTED OR APPROVED
19 BY THE GROUP OR BLANKET POLICY. IF THE INSURED, HIS DEPENDENTS OR BOTH
20 RECEIVE SERVICES FROM A PHARMACY OF THEIR OWN CHOOSING, SUCH INSURED
21 SHALL PAY THE COST OF SUCH PHARMACEUTICAL PRODUCTS TO THE EXTENT THAT
22 SUCH COST EXCEEDS THE BENEFITS PROVIDED UNDER THE GROUP OR BLANKET POLI-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01652-01-1
S. 166 2
1 CY WITHOUT FORFEITURE OF THE BENEFITS PROVIDED UNDER SUCH GROUP OR BLAN-
2 KET POLICY. NO SUCH GROUP OR BLANKET POLICY SHALL PROHIBIT A DULY REGIS-
3 TERED PHARMACY FROM PROVIDING SERVICES, PROVIDED SUCH PHARMACY AGREES TO
4 PROVIDE SUCH SERVICES IN ACCORDANCE WITH THE MINIMUM STANDARDS AND
5 CONDITIONS FOR SIMILAR PROVIDERS THAT HAVE BEEN ESTABLISHED BY SUCH
6 GROUP OR BLANKET POLICY.
7 S 3. Section 4303 of the insurance law is amended by adding a new
8 subsection (hh) to read as follows:
9 (HH) NO SUCH POLICY ISSUED BY A THIRD PARTY BENEFIT PROGRAM SHALL
10 LIMIT BENEFITS OR DENY REIMBURSEMENT FOR SERVICES TO ANY INSURED ON THE
11 BASIS THAT THE PHARMACY PROVIDING SUCH BENEFITS HAS NOT BEEN SPECIF-
12 ICALLY SELECTED OR APPROVED BY THE THIRD PARTY BENEFIT PROGRAM. IF THE
13 INSURED, HIS DEPENDENTS OR BOTH RECEIVE SERVICES FROM A PHARMACY OF
14 THEIR OWN CHOOSING, SUCH INSURED SHALL PAY THE COST OF SUCH TREATMENT TO
15 THE EXTENT THAT SUCH COST EXCEEDS THE BENEFITS PROVIDED UNDER THE POLICY
16 WITHOUT FORFEITURE OF THE BENEFITS PROVIDED UNDER SUCH POLICY. NO SUCH
17 THIRD PARTY BENEFIT PROGRAM SHALL PROHIBIT A DULY REGISTERED PHARMACY
18 FROM PROVIDING SERVICES, PROVIDED SUCH PHARMACY AGREES TO PROVIDE
19 SERVICES IN ACCORDANCE WITH THE MINIMUM STANDARDS AND CONDITIONS FOR
20 SIMILAR PROVIDERS THAT HAVE BEEN ESTABLISHED BY SUCH THIRD PARTY BENEFIT
21 PROGRAM.
22 S 4. Subsection (b) of section 4402 of the insurance law is amended to
23 read as follows:
24 (b) "Employee benefits" means one or more benefits or services for
25 employees or their families or dependents, or for both, including, but
26 not limited to, medical, surgical or hospital care or benefits PROVIDED
27 BY OR PERFORMED BY ANY PHARMACY, benefits in the event of sickness,
28 accident, disability or death, benefits in the event of unemployment, or
29 retirement benefits.
30 S 5. Subsection (b) of section 4413 of the insurance law is amended by
31 adding a new paragraph 1-a to read as follows:
32 (1-A) NO SUCH FUND SHALL LIMIT EMPLOYEE BENEFITS OR DENY REIMBURSEMENT
33 FOR EMPLOYEE BENEFITS TO ANY ELIGIBLE EMPLOYEE ON THE BASIS THAT THE
34 PHARMACY PROVIDING SUCH BENEFITS HAS NOT BEEN SPECIFICALLY SELECTED OR
35 APPROVED BY THE WELFARE FUND, THE EMPLOYER OR THE LABOR ORGANIZATION
36 REPRESENTING THE EMPLOYEES ELIGIBLE FOR SUCH EMPLOYEE BENEFITS. IF THE
37 ELIGIBLE EMPLOYEE, HIS DEPENDENTS OR BOTH RECEIVE SERVICES FROM A PHAR-
38 MACY OF THEIR OWN CHOOSING, SUCH EMPLOYEE SHALL PAY THE COST OF SUCH
39 TREATMENT TO THE EXTENT THAT SUCH COST EXCEEDS THE BENEFITS PROVIDED
40 UNDER THE PLAN WITHOUT FORFEITURE OF THE BENEFITS PROVIDED UNDER SUCH
41 PLAN. NO SUCH FUND, EMPLOYER OR LABOR ORGANIZATION SHALL PROHIBIT A
42 DULY REGISTERED PHARMACY FROM PROVIDING EMPLOYEE BENEFITS, PROVIDED
43 SUCH PHARMACY AGREES TO PROVIDE SUCH SERVICES IN ACCORDANCE WITH THE
44 MINIMUM STANDARDS AND CONDITIONS FOR SIMILAR PROVIDERS THAT HAVE BEEN
45 ESTABLISHED BY SUCH FUND, EMPLOYER OR LABOR ORGANIZATION.
46 S 6. Subsection (b) of section 4301 of the insurance law is amended by
47 adding a new paragraph 4 to read as follows:
48 (4) IF A CONTRACT ISSUED BY A THIRD PARTY BENEFIT PROGRAM PROVIDES
49 BENEFITS FOR PHARMACY SERVICES, PRESCRIPTION DRUGS OR FOR PARTICIPATION
50 IN A PRESCRIPTION DRUG PLAN, ANY PHARMACY WILLING TO PARTICIPATE UNDER
51 THE TERMS OF THE CONTRACT SHALL NOT BE DENIED ACCESS TO THE PROVIDER
52 PANEL.
53 S 7. This act shall take effect on the first of January next succeed-
54 ing the date on which it shall have become a law and shall apply to all
55 policies and contracts issued, renewed, modified, altered or amended on
56 or after such effective date.
