S T A T E   O F   N E W   Y O R K
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                                   101

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 5, 2011
                               ___________

Introduced by M. of A. LATIMER, JAFFEE, GUNTHER, COLTON, CASTRO, LIFTON,
  LUPARDO,  GALEF,  SCHIMEL, ZEBROWSKI -- Multi-Sponsored by -- M. of A.
  BOYLAND, GABRYSZAK, GIBSON, HOOPER, REILLY, THIELE --  read  once  and
  referred to the Committee on Insurance

AN  ACT  to  amend the insurance law, in relation to requiring insurance
  companies to disclose claims information to municipalities

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. The insurance law is amended by adding a new section 3217-e
to read as follows:
  S  3217-E.  DISCLOSURE  OF  INFORMATION  TO  MUNICIPALITIES. (A) EVERY
INSURER CONTRACTING WITH MUNICIPALITIES EMPLOYING FOUR HUNDRED  OR  MORE
EMPLOYEES,  INCLUDING  MUNICIPAL COOPERATIVE HEALTH BENEFIT PLANS CERTI-
FIED PURSUANT TO ARTICLE FORTY-SEVEN OF THIS CHAPTER, SHALL PROVIDE UPON
REQUEST THE FOLLOWING INFORMATION TO THE INSURED MUNICIPALITY:
  (1) SPECIFIC CLAIMS EXPERIENCE COVERED BY THE INSURER UNDER A COMMUNI-
TY RATED OR EXPERIENCED RATED POLICY.   FOR  PURPOSES  OF  THIS  SECTION
"EXPERIENCE  RATINGS"  SHALL  MEAN AND INCLUDE ALL QUANTITATIVE MEASURES
USED BY THE INSURANCE CARRIER  SUCH  AS  EXPENSES  PER  MEMBER  AND  ANY
HISTORICAL DATA;
  (2) AVERAGE ANNUAL PER MEMBER COST OF CLAIMS REIMBURSEMENT;
  (3)  NUMBER  OF MEMBERS WHO DID NOT FILE A CLAIM WITHIN A TWELVE MONTH
PERIOD;
  (4) A COMPARISON OF EMERGENCY SERVICES USED BY MEMBERS TO  OUT-PATIENT
SERVICES;
  (5) A LOSS RATIO REPORT;
  (6)  CLAIMS  HISTORY  FOR  THE LAST TWELVE MONTHS FOR EXPERIENCE RATED
PLANS SEPARATED BY MEDICAL AND PRESCRIPTION;
  (7) INFORMATION REGARDING COST ON  THE  TOP  TWENTY-FIVE  PRESCRIPTION
DRUGS BEING USED BY MEMBER EMPLOYEES;

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
              

                                                           LBD00718-01-1

A. 101                              2

  (8)  LARGE  LOSS  CLAIMS REPORT INDICATING DIAGNOSIS AND PROGNOSIS FOR
CLAIMS GREATER THAN THIRTY THOUSAND DOLLARS;
  (9) MEDICAL LOSS RATIO REPORT; AND
  (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  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 RELATING TO HOW FUNDING WAS SPENT BY  THE
INSURANCE  CARRIER  REGARDING THE INSURED EMPLOYEES. A FINE OF TEN THOU-
SAND DOLLARS PER DAY SHALL BE IMPOSED FOR EACH DAY SUCH FAILURE  CONTIN-
UES.    ANY  FINES  IMPOSED  SHALL  BE  PAID TO THE INSURED MUNICIPALITY
REQUESTING SUCH INFORMATION.
  (C) NOTWITHSTANDING THE FOREGOING PROVISIONS, IN  RELEASING  ANY  SUCH
INFORMATION  THE  INSURER SHALL COMPLY WITH THE FEDERAL HEALTH INSURANCE
PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) OF 1996, AS AMENDED.
  S 2. This act shall take effect immediately.