Bill Text: NY S03461 | 2019-2020 | General Assembly | Introduced


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

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced) 2019-02-07 - REFERRED TO HEALTH [S03461 Detail]

Download: New_York-2019-S03461-Introduced.html


                STATE OF NEW YORK
        ________________________________________________________________________
                                          3461
                               2019-2020 Regular Sessions
                    IN SENATE
                                    February 7, 2019
                                       ___________
        Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
          printed to be committed to the Committee on Health
        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
    22  available  both within the statewide health benefit exchange and outside
    23  of the health benefit exchange.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04689-01-9

        S. 3461                             2
     1    § 3. Section 4306-d of the insurance law, as added by chapter  219  of
     2  the laws of 2011, is amended to read as follows:
     3    §  4306-d.  Choice  of health care provider. (a) A corporation that is
     4  subject to the provisions of this article and requires or  provides  for
     5  designation  by  a  subscriber  of a participating primary care provider
     6  shall permit the subscriber to designate any participating primary  care
     7  provider  who is available to accept such individual, and in the case of
     8  a child, shall permit the subscriber to designate a physician (allopath-
     9  ic or osteopathic) who specializes in pediatrics as the child's  primary
    10  care provider if such provider participates in the network of the corpo-
    11  ration.
    12    (b)  Every corporation that is subject to the provisions of this arti-
    13  cle, shall offer out-of-network coverage as an  optional  rider  to  any
    14  contract  and  shall  offer  at  least one contract option that includes
    15  out-of-network coverage. These options  shall  be  made  available  both
    16  within  the  statewide health benefit exchange and outside of the health
    17  benefit exchange.
    18    § 4. This act shall take effect on the first of January next  succeed-
    19  ing  the  date  on  which it shall have become a law, and shall apply to
    20  contracts and policies issued, renewed, modified or amended on or  after
    21  such date.
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