S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    598
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 9, 2019
                                ___________
 
 Introduced  by  M. of A. L. ROSENTHAL, JAFFEE, STECK, FAHY, JEAN-PIERRE,
   HEVESI, TAYLOR, MONTESANO -- Multi-Sponsored by -- M. of  A.  EPSTEIN,
   SIMON -- 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.
   § 2. Section 3217-e of the insurance law, as added by chapter  219  of
 the laws of 2011, is amended to read as follows:
   §  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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD04689-01-9

 A. 598                              2
 
 AVAILABLE BOTH WITHIN THE STATEWIDE HEALTH BENEFIT EXCHANGE AND  OUTSIDE
 OF THE HEALTH BENEFIT EXCHANGE.
   §  3.  Section 4306-d of the insurance law, as added by chapter 219 of
 the laws of 2011, is amended to read as follows:
   § 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.
   §  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.