S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2826
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 25, 2019
                                ___________
 
 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-i
 to read as follows:
   § 3217-I. 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.
              

                                                            LBD02147-01-9

 A. 2826                             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.
   § 2. This act shall take effect immediately.