S T A T E   O F   N E W   Y O R K
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                                  3734

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                            January 27, 2015
                               ___________

Introduced  by M. of A. ROSENTHAL, LAVINE -- Multi-Sponsored by -- M. of
  A. SKARTADOS -- read once and referred to the Committee on Insurance

AN ACT to amend the public health law and the insurance law, in relation
  to requiring health care insurers to offer coverage  for  health  care
  provided by out-of-network providers

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

  Section 1.  Section 4403 of the public health law is amended by adding
a new subdivision 9 to read as follows:
  9. EVERY HEALTH MAINTENANCE ORGANIZATION  SHALL  OFFER  OUT-OF-NETWORK
COVERAGE  AS  AN OPTIONAL RIDER TO ANY CONTRACT AND SHALL OFFER AT LEAST
ONE CONTRACT OPTION THAT INCLUDES OUT-OF-NETWORK COVERAGE. THESE OPTIONS
SHALL BE  MADE  AVAILABLE  BOTH  WITHIN  THE  STATEWIDE  HEALTH  BENEFIT
EXCHANGE AND OUTSIDE OF THE HEALTH BENEFIT EXCHANGE.
  S  2.  Section 3217-e of the insurance law, as added by chapter 219 of
the laws of 2011, is amended to read as follows:
  S 3217-e. Choice of health care  provider.  (A)  An  insurer  that  is
subject  to  this article and requires or provides for designation by an
insured of a  participating  primary  care  provider  shall  permit  the
insured  to  designate  any  participating  primary care provider who is
available to accept such individual, and in the case of a  child,  shall
permit  the insured to designate a physician (allopathic or osteopathic)
who specializes in pediatrics as the child's primary  care  provider  if
such provider participates in the network of the insurer.
  (B)  EVERY  INSURER THAT OFFERS HEALTH INSURANCE AND IS SUBJECT TO THE
PROVISIONS OF THIS ARTICLE, SHALL OFFER OUT-OF-NETWORK  COVERAGE  AS  AN
OPTIONAL  RIDER TO ANY POLICY AND SHALL OFFER AT LEAST ONE POLICY OPTION
THAT INCLUDES OUT-OF-NETWORK  COVERAGE.  THESE  OPTIONS  SHALL  BE  MADE
AVAILABLE  BOTH WITHIN THE STATEWIDE HEALTH BENEFIT EXCHANGE AND OUTSIDE
OF THE HEALTH BENEFIT EXCHANGE.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04257-02-5

              

A. 3734                             2

  S 3. Section 4306-d of the insurance law, as added by chapter  219  of
the laws of 2011, is amended to read as follows:
  S  4306-d.  Choice  of health care provider. (A) A corporation that is
subject to the provisions of this article and requires or  provides  for
designation  by  a  subscriber  of a participating primary care provider
shall permit the subscriber to designate any participating primary  care
provider  who is available to accept such individual, and in the case of
a child, shall permit the subscriber to designate a physician (allopath-
ic or osteopathic) who specializes in pediatrics as the child's  primary
care provider if such provider participates in the network of the corpo-
ration.
  (B)  EVERY CORPORATION THAT IS SUBJECT TO THE PROVISIONS OF THIS ARTI-
CLE, SHALL OFFER OUT-OF-NETWORK COVERAGE AS AN  OPTIONAL  RIDER  TO  ANY
CONTRACT  AND  SHALL  OFFER  AT  LEAST ONE CONTRACT OPTION THAT INCLUDES
OUT-OF-NETWORK COVERAGE. THESE OPTIONS  SHALL  BE  MADE  AVAILABLE  BOTH
WITHIN  THE  STATEWIDE HEALTH BENEFIT EXCHANGE AND OUTSIDE OF THE HEALTH
BENEFIT EXCHANGE.
  S 4. This act shall take effect on the first of January next  succeed-
ing  the  date  on  which it shall have become a law, and shall apply to
contracts and policies issued, renewed, modified or amended on or  after
such date.