NY State Senate Bill 2017-S5779A

Senate Bill S5779A

2017-2018 Legislative Session

Requires health insurers to provide health care providers with the coverage a policyholder or covered person has, when liability is unclear

download bill text pdf

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 03, 2018	referred to insurance
Jun 21, 2017	recommitted to rules ordered to third reading cal.2213 committee discharged and committed to rules
Jun 19, 2017	print number 5779a
Jun 19, 2017	amend and recommit to insurance
Apr 28, 2017	referred to insurance

Votes

- Jun 21, 2017 - Rules Committee Vote
  S5779A
  
  23
  
  Aye
  
  0
  
  Nay
  
  2
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Rules Committee Vote: Jun 21, 2017
      
      aye (23)
      
      Bonacic
      
      Breslin
      
      Carlucci
      
      DeFrancisco
      
      Dilan
      
      Flanagan
      
      Gianaris
      
      Griffo
      
      Hannon
      
      Kennedy
      
      LaValle
      
      Lanza
      
      Larkin
      
      Little
      
      Marcellino
      
      Montgomery
      
      Parker
      
      Ranzenhofer
      
      Robach
      
      Savino
      
      Squadron
      
      Stewart-Cousins
      
      Valesky
      
      aye wr (2)
      
      Krueger
      
      Seward

Bill Amendments

Original

A (Active)

2017-S5779 - Details

See Assembly Version of this Bill:: A8063
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §3224-a, Ins L
Versions Introduced in Other Legislative Sessions:: 2015-2016: S7370
2019-2020: S6341

2017-S5779 - Summary

Requires health insurers to provide health care providers with the coverage a policyholder or covered person has, when liability for a health care claim is not reasonably clear.

2017-S5779 - Sponsor Memo

                                 BILL NUMBER:  S5779

 TITLE OF BILL :  An act to amend the insurance law, in relation to
requiring health insurers to provide, when liability for a claim is
not reasonably clear, the coverage the policyholder or covered person
is enrolled in

 PURPOSE :

The require plans to clearly identify to a provider the product an
individual is enrolled in for health coverage purposes.

 SUMMARY OF PROVISIONS :

Section 1 amends subsection (b) of paragraph (2) of section 3224-a of
the Insurance Law to add a new requirement that an insurer identify
the specific type of plan or product the policy-holder or covered
person is enrolled in.

Section 2 amends subsection (d) of section 3224-a of the Insurance law
to add a new paragraph 3 to define the plans or products that must be
identified by the insurer.

Section 3 provides that this act shall take effect July 1, 2018.

 JUSTIFICATION :

Hospitals and health care providers are currently challenged with
identifying which specific health plan a patient is enrolled in.
Health plans today offer a wide variety of products, which can make it
very difficult to identify what particular health coverage a patient
has. There is no requirement for plans to consistently and uniformly
identify what particular product an individual is enrolled in.

The current inability to identify these products or the regulatory
rules that apply causes providers, regulators, and plans to waste
valuable resources appealing, communicating, and replacing claims
incorrectly or when it is not necessary. Under the current system,
identification of the type of coverage is ultimately made after an
appeal is submitted by a patient or a provider and after these
resources have already been wasted.

This bill would ensure plans provide the necessary information at the
time the plan makes a payment determination. This will avoid wasting
time and energy on filing unnecessary appeals and identify protections
available for patients based on their particular coverage by ensuring
clear and consistent information about the particular product a
patient is enrolled in.

 LEGISLATIVE HISTORY :

2016: S.7370

 FISCAL IMPLICATIONS :

None

 EFFECTIVE DATE :
July 1, 2018

2017-S5779 - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5779
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                              April 28, 2017
                                ___________
 
 Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance  law,  in  relation  to  requiring  health
   insurers  to  provide,  when  liability  for a claim is not reasonably
   clear, the coverage the policyholder or covered person is enrolled in

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Paragraph  2  of  subsection (b) of section 3224-a of the
 insurance law, as amended by chapter 237 of the laws of 2009, is amended
 and a new paragraph 3 is added to read as follows:
   (2) to request all additional information needed to determine  liabil-
 ity to pay the claim or make the health care payment[.]; AND
   (3)  OF  THE  SPECIFIC  TYPE  OF  PLAN  OR PRODUCT THE POLICYHOLDER OR
 COVERED PERSON IS ENROLLED IN.
   § 2. Subsection (d) of section 3224-a of the insurance law is  amended
 by adding a new paragraph 3 to read as follows:
   (3) "PLAN OR PRODUCT" SHALL MEAN:
   (I)  MEDICAID  COVERAGE  CERTIFIED  PURSUANT  TO SECTION THREE HUNDRED
 SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW;
   (II) A CHILD HEALTH INSURANCE PLAN CERTIFIED PURSUANT TO SECTION TWEN-
 TY-FIVE HUNDRED ELEVEN OF THE PUBLIC HEALTH LAW;
   (III) BASIC HEALTH PROGRAM  COVERAGE  CERTIFIED  PURSUANT  TO  SECTION
 THREE  HUNDRED  SIXTY-NINE-GG  OF THE SOCIAL SERVICES LAW, INCLUDING THE
 SPECIFIC RATING GROUP THE POLICYHOLDER OR COVERED PERSON IS ENROLLED IN;
   (IV) COVERAGE PURCHASED ON THE NEW YORK INSURANCE EXCHANGE ESTABLISHED
 PURSUANT TO ARTICLE SIXTY-TWO OF THIS CHAPTER; AND
   (V) ANY OTHER PRODUCT FULLY INSURED AND REGULATED BY THE  STATE  UNDER
 ARTICLE FORTY-TWO, FORTY-THREE, OR FORTY-SEVEN OF THIS CHAPTER, OR ARTI-
 CLE FORTY-FOUR OF THE PUBLIC HEALTH LAW.
   § 3. This act shall take effect July 1, 2018.

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11297-01-7

2017-S5779A (ACTIVE) - Details

See Assembly Version of this Bill:: A8063
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §3224-a, Ins L
Versions Introduced in Other Legislative Sessions:: 2015-2016: S7370
2019-2020: S6341

2017-S5779A (ACTIVE) - Summary

Requires health insurers to provide health care providers with the coverage a policyholder or covered person has, when liability for a health care claim is not reasonably clear.

2017-S5779A (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S5779A

 TITLE OF BILL :  An act to amend the insurance law, in relation to
requiring health insurers to provide, when liability for a claim is
not reasonably clear, the coverage the policyholder or covered person
is enrolled in

 PURPOSE :

The require plans to clearly identify to a provider the product an
individual is enrolled in for health coverage purposes.

 SUMMARY OF PROVISIONS :

Section 1 amends subsection (b) of paragraph (2) of section 3224-a of
the Insurance Law to add a new requirement that an insurer identify
the specific type of plan or product the policy-holder or covered
person is enrolled in.

Section 2 amends subsection (d) of section 3224-a of the Insurance law
to add a new paragraph 3 to define the plans or products that must be
identified by the insurer.

Section 3 provides that this act shall take effect July 1, 2018.

 JUSTIFICATION :

Hospitals and health care providers are currently challenged with
identifying which specific health plan a patient is enrolled in.
Health plans today offer a wide variety of products, which can make it
very difficult to identify what particular health coverage a patient
has. There is no requirement for plans to consistently and uniformly
identify what particular product an individual is enrolled in.

The current inability to identify these products or the regulatory
rules that apply causes providers, regulators, and plans to waste
valuable resources appealing, communicating, and replacing claims
incorrectly or when it is not necessary. Under the current system,
identification of the type of coverage is ultimately made after an
appeal is submitted by a patient or a provider and after these
resources have already been wasted.

This bill would ensure plans provide the necessary information at the
time the plan makes a payment determination. This will avoid wasting
time and energy on filing unnecessary appeals and identify protections
available for patients based on their particular coverage by ensuring
clear and consistent information about the particular product a
patient is enrolled in.

 LEGISLATIVE HISTORY :

2016: S.7370

 FISCAL IMPLICATIONS :

None

 EFFECTIVE DATE :
July 1, 2018

2017-S5779A (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5779--A
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                              April 28, 2017
                                ___________
 
 Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
   printed to be committed to the Committee  on  Insurance  --  committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee
 
 AN  ACT  to  amend  the  insurance  law, in relation to requiring health
   insurers to provide, when liability for  a  claim  is  not  reasonably
   clear, the coverage the policyholder or covered person is enrolled in
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraph 2 of subsection (b)  of  section  3224-a  of  the
 insurance law, as amended by chapter 237 of the laws of 2009, is amended
 and a new paragraph 3 is added to read as follows:
   (2)  to request all additional information needed to determine liabil-
 ity to pay the claim or make the health care payment[.]; AND
   (3) OF THE SPECIFIC TYPE  OF  PLAN  OR  PRODUCT  THE  POLICYHOLDER  OR
 COVERED  PERSON  IS  ENROLLED  IN; PROVIDED THAT NOTHING IN THIS SECTION
 SHALL AUTHORIZE DISCRIMINATION BASED ON THE SOURCE OF PAYMENT.
   § 2. Subsection (d) of section 3224-a of the insurance law is  amended
 by adding a new paragraph 3 to read as follows:
   (3) "PLAN OR PRODUCT" SHALL MEAN:
   (I)  MEDICAID  COVERAGE  CERTIFIED  PURSUANT  TO SECTION THREE HUNDRED
 SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW;
   (II) A CHILD HEALTH INSURANCE PLAN CERTIFIED PURSUANT TO SECTION TWEN-
 TY-FIVE HUNDRED ELEVEN OF THE PUBLIC HEALTH LAW;
   (III) BASIC HEALTH PROGRAM  COVERAGE  CERTIFIED  PURSUANT  TO  SECTION
 THREE  HUNDRED  SIXTY-NINE-GG  OF THE SOCIAL SERVICES LAW, INCLUDING THE
 SPECIFIC RATING GROUP THE POLICYHOLDER OR COVERED PERSON IS ENROLLED IN;
   (IV) COVERAGE PURCHASED ON THE NEW YORK INSURANCE EXCHANGE ESTABLISHED
 PURSUANT TO ARTICLE SIXTY-TWO OF THIS CHAPTER; AND

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11297-03-7

 S. 5779--A                          2
 
   (V) ANY OTHER PRODUCT FULLY INSURED AND REGULATED BY THE  STATE  UNDER
 ARTICLE FORTY-TWO, FORTY-THREE, OR FORTY-SEVEN OF THIS CHAPTER, OR ARTI-
 CLE FORTY-FOUR OF THE PUBLIC HEALTH LAW.
   § 3. This act shall take effect July 1, 2018.

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