Bill Text: NY S05639 | 2023-2024 | General Assembly | Amended

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Bill Title: Clarifies that the New York state health insurance program remains subject to certain provisions of the financial services law and coverage for usual and customary costs for out-of-network health care service.

Spectrum: Moderate Partisan Bill (Democrat 12-2)

Status: (Introduced) 2024-01-03 - REFERRED TO CIVIL SERVICE AND PENSIONS [S05639 Detail]

Download: New_York-2023-S05639-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                         5639--A

                               2023-2024 Regular Sessions

                    IN SENATE

                                     March 10, 2023
                                       ___________

        Introduced  by  Sen. JACKSON -- read twice and ordered printed, and when
          printed to be committed to the Committee on Civil Service and Pensions
          -- committee discharged, bill amended, ordered  reprinted  as  amended
          and recommitted to said committee

        AN  ACT  to  amend the civil service law, in relation to clarifying that
          the New York state health insurance program remains subject to certain
          provisions of the financial services law

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1.  Subparagraph  (iv)  of  paragraph (b) of subdivision 1 of
     2  section 162 of the  civil service law, as amended by section 3 of part T
     3  of chapter 56 of the laws of 2010 and as further amended by section  104
     4  of  part  A  of  chapter  62  of the laws of 2011, is amended to read as
     5  follows:
     6    (iv) Notwithstanding the provisions of this  subdivision,  the  presi-
     7  dent's election to provide health benefits directly to plan participants
     8  shall  not constitute the doing of insurance business within the meaning
     9  of article eleven of the insurance law; provided however, the  provision
    10  of direct benefits as per this subdivision shall be subject to review by
    11  the  superintendent  of  financial services for the purposes of ensuring
    12  compliance with applicable insurance law  and  any  and  all  associated
    13  insurance  rules and regulations as noted in this subdivision.  Further,
    14  the provision of direct benefits as per this subdivision, and any entity
    15  providing administrative services regarding  those  benefits,  shall  be
    16  subject  to  the jurisdiction of the department of financial services in
    17  accordance with article three of the financial services law, as well  as
    18  the provisions of article six of the financial services law.
    19    § 2. Subparagraph (i) of paragraph (b) of subdivision 1 of section 162
    20  of  the  civil service law, as amended by section 3 of part T of chapter
    21  56 of the laws of 2010, is amended to read as follows:

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09746-02-3
        S. 5639--A                          2

     1    (i) Any and all health insurance coverage mandated by any law, rule or
     2  regulation, including but not limited to coverage mandated  pursuant  to
     3  article  forty-three  of  the insurance law, applicable to contracts for
     4  health insurance entered into under this section shall be provided in  a
     5  manner  assuring  uninterrupted  continuance of coverage for all covered
     6  persons. Health benefits shall include a requirement that covered health
     7  care services provided to plan participants will be  reimbursed  at  the
     8  level of at least eighty percent of the usual and customary cost of each
     9  out-of-network  health    care  service.  As  used in this subparagraph,
    10  "usual and customary cost" shall mean the eightieth  percentile  of  all
    11  charges  for  the particular health care service performed by a provider
    12  in the same or similar specialty and provided in the  same  geographical
    13  area  as  reported  in a benchmarking database maintained by a nonprofit
    14  organization specified by the superintendent of financial services.  For
    15  the purposes of this paragraph "coverage" shall include but shall not be
    16  limited  to  all  benefits,  services, rights, privileges and guarantees
    17  allowed by law;
    18    § 3. Subdivision 1 of section 161-a  of  the  civil  service  law,  as
    19  amended  by  section  10 of part T of chapter 56 of the laws of 2010, is
    20  amended to read as follows:
    21    1. Where, and to the extent that, an agreement between the  state  and
    22  an  employee  organization  entered into pursuant to article fourteen of
    23  this chapter provides for health benefits, the president, after  receipt
    24  of  written  directions  from  the director of employee relations, shall
    25  implement the provisions of such agreement  consistent  with  the  terms
    26  thereof  and  to  the extent necessary shall adopt regulations providing
    27  for the benefits to be thereunder  provided.  The  president,  with  the
    28  approval  of  the  director  of the budget, may extend such benefits, in
    29  whole or in part, provided that such benefits are not a diminishment  of
    30  current  existing benefits to employees not subject to the provisions of
    31  such agreement.
    32    § 4. This act shall take effect immediately.