BILL NUMBER:S1120

TITLE OF BILL:
An act
to amend the insurance law, in relation to requiring insurance companies
to disclose claims information to municipalities

PURPOSE OR GENERAL IDEA OF BILL:
This bill allows the different levels
of government employing 400 or more workers an opportunity to assess
accurately the true needs of their employees when addressing health
care benefits. It will create transparency allowing these governments
to' negotiate more effectively with all insurance companies that are
bidding on future contracts.

SUMMARY OF SPECIFIC PROVISIONS:
Section 1. Amends the insurance law by adding a new section 3217-e to
read as follows:

§3217-C Disclosure of information, to municipalities. (a) Every
insurer contracting with municipalities, including cooperative health
benefit plans certified pursuant to article forty-seven of this
chapter shall provide upon request the following information to the
insured municipality.

1. Specific claims information must be furnished by the insurer under
              

community rated or experience rated policies;

2. Average annual per member cost of claims reimbursement;

3. Number of members that did not file a claim within a 12 month period;

4. A comparison of emergency services used by members to out-patient
services; and

5. Provide municipality with loss ratio report.

6. Claims history for the last 12 months must be provided for
experience rated plans separated by medical and prescription.

7 Information regarding cost on to 25 prescription drug being used by
member employees.

8. Large loss claims report indicating diagnosis and prognosis for
claims greater than $30 000.00.

9. Medical loss ratio report.

10. Any other statistical information the municipality requests to
determine use of benefits by members.

B. The superintendent shall impose a fine of three hundred thousand
dollars ($300,000) for failure to provide within thirty days of a
written request by the insured municipality the information required
by paragraph one of subsection (a) of this section regarding the
insured employees. A fine of ten thousand dollars ($10,000) a day


will be imposed for every day such failure continues. Any fines
imposed shall be paid directly to the municipality requesting such
information.

C. All information being released shall be done so in compliance with
the federal health insurance portability and accountability act
(HIPAA) of 1996.

Definition

The experience ratings will include all quantitative measures used by
the insurance company such as expenses per member, data supporting
said expenses and any historical data that will help determine the
risk of future claims.
This information will provide transparency for purposes of negotiations
in future contracts.

JUSTIFICATION:
Every year villages, towns, cities and counties in New
York State are forced to put in place a budget that best meets the
needs of those governments. It is necessary for those creating
budgets to have access to accurate numbers that reflect a true need.
Without understanding how well health care programs are being
utilized, it is very difficult to negotiate in good faith with
insurance carriers. Large insurance carriers will continue to have an
unfair advantage over governments until transparencies exist and
negotiations reflect actual cost.

PRIOR LEGISLATIVE HISTORY:
2009-10:  S.7560/A.9130B - Referred to Insurance

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This act will take effect immediately.