S T A T E   O F   N E W   Y O R K
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                                  8641

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                           September 21, 2011
                               ___________

Introduced  by  M.  of  A.  ZEBROWSKI  --  read once and referred to the
  Committee on Insurance

AN ACT to amend the insurance law,  in  relation  to  requiring  medical
  insurers to permit patients to assign their payment

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

  Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
amended by adding a new paragraph 28 to read as follows:
  (28)  EVERY  POLICY  WHICH  PROVIDES MEDICAL, MAJOR-MEDICAL OR SIMILAR
COMPREHENSIVE-TYPE COVERAGE SHALL PERMIT A PATIENT TO ASSIGN HIS OR  HER
PAYMENT  TO THE PROVIDER OF SUCH HOSPITAL, SURGICAL OR MEDICAL SERVICES,
REGARDLESS OF WHETHER THE PROVIDER IS IN  THE  NETWORK  OF  HEALTH  CARE
PROVIDERS  OFFERED  BY THE INSURER ISSUING THE POLICY, PROVIDED THAT THE
SERVICES RENDERED TO THE PATIENT BY THE PROVIDER ARE  OTHERWISE  COVERED
UNDER THE POLICY.
  S  2.  Section  3221  of  the insurance law is amended by adding a new
subsection (s) to read as follows:
  (S) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY  IN
THIS  STATE  WHICH PROVIDES HOSPITAL, SURGICAL OR MEDICAL COVERAGE SHALL
PERMIT A PATIENT TO ASSIGN HIS OR HER PAYMENT TO THE  PROVIDER  OF  SUCH
HOSPITAL,  SURGICAL  OR  MEDICAL  SERVICES,  REGARDLESS  OF  WHETHER THE
PROVIDER IS IN THE NETWORK OF  HEALTH  CARE  PROVIDERS  OFFERED  BY  THE
INSURER  ISSUING  THE POLICY, PROVIDED THAT THE SERVICES RENDERED TO THE
PATIENT BY THE PROVIDER ARE OTHERWISE COVERED UNDER THE POLICY.
  S 3.  Section 3224-a of the insurance law is amended by adding  a  new
subsection (i) to read as follows:
  (I)  WHERE  PAYMENT  FOR  ANY PORTION OF A CLAIM IS MADE DIRECTLY TO A
HEALTH CARE PROVIDER, SUCH INSURER OR ORGANIZATION OR CORPORATION  SHALL
PROVIDE AT THE TIME PAYMENT IS MADE WRITTEN NOTIFICATION OF SUCH PAYMENT
TO  THE  POLICYHOLDER  WHO  RENDERED THE SERVICE FOR WHICH THE CLAIM WAS
PAID. SUCH NOTIFICATION SHALL INCLUDE, BUT NOT BE LIMITED TO, THE AMOUNT

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD13394-01-1
              

A. 8641                             2

PAID TO THE HEALTH CARE PROVIDER, THE  PERCENTAGE  OF  THE  TOTAL  CLAIM
REPRESENTED BY THE PAYMENT, THE SERVICES FOR WHICH PAYMENT WAS MADE, THE
HEALTH  CARE  PROVIDER PROVIDING THOSE SERVICES AND THE CALCULATIONS FOR
PAYMENT,   BY  SERVICE  PROVIDED,  INCLUDING  CO-PAYMENTS,  DEDUCTIBLES,
SURCHARGES AND FEE SCHEDULES.
  S 4. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (a-1) to read as follows:
  (A-1) EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION
OR  HEALTH  SERVICE CORPORATION WHICH PROVIDES MEDICAL, MAJOR MEDICAL OR
SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PERMIT A PATIENT TO ASSIGN HIS
OR HER BENEFITS TO THE PROVIDER OF SUCH HOSPITAL,  SURGICAL  OR  MEDICAL
SERVICES, REGARDLESS OF WHETHER THE PROVIDER IS IN THE NETWORK OF HEALTH
CARE  PROVIDERS OFFERED BY THE INSURER ISSUING THE POLICY, PROVIDED THAT
THE SERVICES RENDERED TO THE  PATIENT  BY  THE  PROVIDER  ARE  OTHERWISE
COVERED UNDER THE POLICY.
  S  5.  This  act shall take effect on the ninetieth day after it shall
have become a law and shall apply  to  policies  and  contracts  issued,
renewed, modified, altered or amended on or after such date.