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

                                  9305

                          I N  A S S E M B L Y

                            February 17, 2016
                               ___________

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

AN ACT to amend the insurance  law,  in  relation  to  requiring  health
  insurers  to provide insureds and covered persons the option to assign
  the payment of emergency services  benefits  directly  to  an  out  of
  network health care provider

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

  Section 1. Subsection (c) of section 3241 of  the  insurance  law,  as
added  by  section  6  of  part  H of chapter 60 of the laws of 2014, is
amended to read as follows:
  (c) (1) When an insured or enrollee under a contract  or  policy  that
provides  coverage  for  emergency services receives the services from a
health care provider that does not participate in the  provider  network
of  an  insurer, a corporation organized pursuant to article forty-three
of this chapter, a municipal cooperative health benefit  plan  certified
pursuant  to  article  forty-seven of this chapter, a health maintenance
organization certified pursuant to  article  forty-four  of  the  public
health  law, or a student health plan established or maintained pursuant
to section one thousand one hundred twenty-four of this chapter ("health
care plan"), the health care plan  shall  ensure  that  the  insured  or
enrollee shall (A) incur no greater out-of-pocket costs for the emergen-
cy  services  than  the  insured  or enrollee would have incurred with a
health care provider that participates in the health care plan's provid-
er network AND (B) PROVIDE THE INSURED OR ENROLLEE THE OPTION OF ASSIGN-
ING THE PAYMENT OF ANY  BENEFITS  DUE  UNDER  SUCH  CONTRACT  OR  POLICY
DIRECTLY  TO THE HEALTH CARE PROVIDER. WHENEVER, IN ANY HEALTH INSURANCE
CLAIM FORM, AN INSURED OR ENROLLEE SPECIFICALLY AUTHORIZES  THE  PAYMENT
OF  BENEFITS  DIRECTLY  TO  A HEALTH CARE PROVIDER, THE HEALTH CARE PLAN
SHALL MAKE SUCH PAYMENT TO THE  HEALTH  CARE  PROVIDER.    (2)  For  the
purpose of this section, "emergency services" shall have the meaning set
forth in subparagraph (D) of paragraph nine of subsection (i) of section
three  thousand two hundred sixteen of this article, subparagraph (D) of
paragraph four of subsection (k) of section three thousand  two  hundred

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

                                                           LBD13383-02-6

A. 9305                             2

twenty-one  of  this  article,  and subparagraph (D) of paragraph two of
subsection (a) of section four thousand  three  hundred  three  of  this
chapter.
  S  2.  This  act shall take effect on the ninetieth day after it shall
have become a law.