S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5145
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                              April 11, 2019
                                ___________
 
 Introduced  by  Sen.  RIVERA -- 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 the designation of  an
   independent consumer assistance program
 
   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 211 to
 read as follows:
   § 211. INDEPENDENT CONSUMER ASSISTANCE PROGRAM. THE SUPERINTENDENT, IN
 CONSULTATION WITH THE COMMISSIONER OF HEALTH, SHALL DESIGNATE  AN  INDE-
 PENDENT CONSUMER ASSISTANCE PROGRAM THAT WILL HAVE THE FOLLOWING DUTIES:
   (A) THE INDEPENDENT CONSUMER ASSISTANCE PROGRAM SHALL:
   (1)  ASSIST  CONSUMERS  WITH  THE  FILING  OF  COMPLAINTS AND APPEALS,
 INCLUDING FILING APPEALS WITH THE INTERNAL APPEAL OR  GRIEVANCE  PROCESS
 OF  THE  GROUP  HEALTH  PLANS  OR  HEALTH INSURANCE ISSUERS INVOLVED AND
 PROVIDING INFORMATION ABOUT AND ASSISTING CONSUMERS  WITH  THE  EXTERNAL
 APPEALS AND ADMINISTRATIVE HEARING PROCESS;
   (2) COLLECT, TRACK, AND QUANTIFY PROBLEMS AND INQUIRIES ENCOUNTERED BY
 CONSUMERS;
   (3)  EDUCATE  CONSUMERS  ON  THEIR  RIGHTS  AND  RESPONSIBILITIES WITH
 RESPECT TO GROUP HEALTH PLANS AND HEALTH INSURANCE COVERAGE;
   (4) ASSIST CONSUMERS WITH ENROLLMENT IN A GROUP HEALTH PLAN OR  HEALTH
 INSURANCE COVERAGE BY PROVIDING INFORMATION, REFERRAL, AND ASSISTANCE;
   (5)  RESOLVE PROBLEMS WITH OBTAINING PREMIUM TAX CREDITS UNDER SECTION
 36B OF THE INTERNAL REVENUE CODE OF 1986;
   (6) ASSIST CONSUMERS WITH DISPUTES ELIGIBLE FOR RESOLUTION UNDER ARTI-
 CLE SIX OF THE FINANCIAL SERVICES LAW;
   (7) ASSIST UNINSURED, INSURED, OR UNDERINSURED CONSUMERS IN  ACCESSING
 APPROPRIATE  HEALTH  CARE SERVICES, HOSPITAL FINANCIAL ASSISTANCE OR THE
 RESOLUTION OF THEIR HEALTH CARE BILLS; AND
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11109-01-9
              

 S. 5145                             2
 
   (8) PROVIDE ASSISTANCE TO HEALTH CONSUMERS ON ANY  ADDITIONAL  MATTERS
 RELATED TO ACCESSING HEALTH INSURANCE COVERAGE AND HEALTH CARE SERVICES.
   (B)  ALL  NEW  YORK  STATE REGULATED HEALTH PLANS SHALL BE REQUIRED TO
 LIST THE NAME, PHONE NUMBER, ADDRESS AND EMAIL OF THE STATE  INDEPENDENT
 CONSUMER ASSISTANCE PROGRAMS ON NOTICES TO CONSUMERS OF ADVERSE DETERMI-
 NATIONS  AND  EXPLANATION  OF  BENEFITS AND IN THE SUBSCRIBER AGREEMENT,
 MEMBER HANDBOOK AND ANY ADDITIONAL CONSUMER FACING MATERIALS  AS  DETER-
 MINED BY THE SUPERINTENDENT AND THE COMMISSIONER OF HEALTH.
   § 2. This act shall take effect immediately.