S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8035
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                            September 13, 2023
                                ___________
 
 Introduced  by M. of A. STECK -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to electronic notification when prior  authorization  is  required  to
   fill a prescription
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraphs 13 and 14 of subsection (b) of section 3217-a of
 the insurance law, as added by section 2 of part H of chapter 60 of  the
 laws  of  2014,  are  amended and a new paragraph 15 is added to read as
 follows:
   (13) disclose whether a health care provider scheduled  to  provide  a
 health care service is an in-network provider; [and]
   (14) with respect to out-of-network coverage, disclose the approximate
 dollar  amount  that  the insurer will pay for a specific out-of-network
 health care service. The insurer shall also inform the  insured  through
 such  disclosure  that  such approximation is not binding on the insurer
 and that the approximate dollar amount that the insurer will pay  for  a
 specific out-of-network health care service may change[.]; AND
   (15)  WHERE  APPLICABLE,  ALLOW  AN  INSURED  TO REQUEST AN ELECTRONIC
 NOTIFICATION WITHIN THIRTY DAYS WHEN PRIOR AUTHORIZATION IS REQUIRED  TO
 FILL A PRESCRIPTION.
   §  2.  Paragraphs  13  and 14 of subsection (b) of section 4324 of the
 insurance law, as added by section 9 of part H of chapter 60 of the laws
 of 2014, are amended and a new paragraph 15 is added to read as follows:
   (13) disclose whether a health care provider scheduled  to  provide  a
 health care service is an in-network provider; [and]
   (14) with respect to out-of-network coverage, disclose the approximate
 dollar  amount  that the corporation will pay for a specific out-of-net-
 work health care service. The corporation shall also inform the  insured
 through  such  disclosure  that such approximation is not binding on the

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD13192-01-3
              

 A. 8035                             2
 
 corporation and that the approximate dollar amount that the  corporation
 will   pay  for  a  specific  out-of-network  health  care  service  may
 change[.]; AND
   (15)  WHERE  APPLICABLE,  ALLOW  AN  INSURED  TO REQUEST AN ELECTRONIC
 NOTIFICATION WITHIN THIRTY DAYS WHEN PRIOR AUTHORIZATION IS REQUIRED  TO
 FILL A PRESCRIPTION.
   §  3.  Paragraphs  (m) and (n) of subdivision 2 of section 4408 of the
 public health law, as added by section 19 of part H of chapter 60 of the
 laws of 2014, are amended and a new paragraph (o) is added  to  read  as
 follows:
   (m)  disclose  whether  a  health care provider scheduled to provide a
 health care service is an in-network provider; [and]
   (n) with respect to out-of-network coverage, disclose the  approximate
 dollar  amount  that  the health maintenance organization will pay for a
 specific out-of-network health  care  service.  The  health  maintenance
 organization  shall also inform an enrollee through such disclosure that
 such approximation is not binding on the health maintenance organization
 and that the approximate  dollar  amount  that  the  health  maintenance
 organization  will pay for a specific out-of-network health care service
 may change[.]; AND
   (O) WHERE APPLICABLE,  ALLOW  AN  INSURED  TO  REQUEST  AN  ELECTRONIC
 NOTIFICATION  WITHIN THIRTY DAYS WHEN PRIOR AUTHORIZATION IS REQUIRED TO
 FILL A PRESCRIPTION.
   § 4. This act shall take effect immediately.