S T A T E   O F   N E W   Y O R K
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                                  7291

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                              May 10, 2013
                               ___________

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  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-g
to read as follows:
  S 3217-G. 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;
  (8) LARGE LOSS CLAIMS REPORT INDICATING DIAGNOSIS  AND  PROGNOSIS  FOR
CLAIMS GREATER THAN THIRTY THOUSAND DOLLARS;
  (9) MEDICAL LOSS RATIO REPORT; AND

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05135-01-3
              

A. 7291                             2

  (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.