BILL NUMBER: S5592

SPONSOR: COMRIE
 
TITLE OF BILL:

An act to amend the insurance law and the public health law, in relation
to disclosure and access to health insurance plan documents

 
PURPOSE:

This bill requires that within thirty days of a request by an insured or
prospective insured, a health insurer shall supply a copy of the most
recent group insurance policy or contract to a subscriber.

 
SUMMARY OF PROVISIONS:

Section 1: Amends Insurance Law section 3217-a to require that all
insurers that offer comprehensive, expense-reimbursed health insurance
contracts, managed care contracts, or other health insurance contracts
shall provide, upon request, to an insured or subscriber, within 30
days, a copy of the most recent group policy or contract to such insured
or subscriber.
              

Section 2: Amends Insurance Law section 4324 to require all Article 43
corporations that offer comprehensive, expense-reimbursed contracts, or
managed care products, shall provide, upon request, to an insured or
subscriber, within 30 days, a copy of the most recent group policy or
contract to such insured or subscriber.

Section 3: Amends Public Health Law section 4408 to require all Health
Maintenance Organizations that offer managed health care products, shall
provide, upon request, to a health care subscriber, within 30 days, a
copy of the most recent group contract to such subscriber.

 
EXISTING LAW:

Under current law, individual direct pay subscribers are able to obtain,
upon request, a copy of their health insurance policy or contract. This
provision is, however, not extended to those policyholders or subscrib-
ers that have group or other managed care health insurance products.

 
JUSTIFICATION:

The process by which health insurance contracts are negotiated has
become more complex. Generally, health insurance policies or contracts
for educational employees are purchased bases on negotiations between
the health insurer and individual school districts or a cooperative
group of employees in several, school districts. Because these contracts
are embodied in collective bargaining agreements reached between each
employer and its employees, there are several different health insurance
contracts held by individual school districts within a consortium.

At a time when health care benefits and their costs are constantly
changing, it is important for all parties to be informed of their bene-
fit coverages and costs. All insureds should be fully aware of their
coverage levels and costs for such coverage levels. Under current law,
while a policyholder, subscriber or employer school district may have
access to a summary of the insurance contract, there is no clear way for
such persons or school district to obtain an actual copy of the policy,
contract or certificate. This can be particularly harmful to an insured
because in the event of inconsistency between the insurance coverage
summary and the actually executed policy or contract, the terms of the
executed contract control the level of coverage and its costs. Under
current law, health insurers may modify the level or type of coverage
without each individual insured's knowledge of such changes.

In some cases, the employee insured may only find out about the change
in coverage when the statement of payment is received. Also, the current
system obstructs the ability to adjudicate a claim dispute and makes it
difficult for employers and employee representatives to make informed
decisions regarding plan design and content and to compare competitive
proposals without the contract.

 
LEGISLATIVE HISTORY:

Previously Introduced; 2017/18 A.2054

2021-2022: S5529

 
FISCAL IMPLICATIONS:

None.

 
LOCAL FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect on the sixtieth day after it shall have
become a law.