S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3488
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 28, 2025
                                ___________
 
 Introduced  by M. of A. DILAN -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the insurance law, in relation to requiring notification
   to insured persons that an out-of-network physician  may  be  used  in
   their procedure, test or surgery
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 3216 of the insurance law is amended  by  adding  a
 new subsection (n) to read as follows:
   (N)  (1)  EVERY  PERSON  INSURED UNDER A POLICY OF ACCIDENT AND HEALTH
 INSURANCE DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE SHALL BE  ENTI-
 TLED  TO  NOTIFICATION  FROM  THE BILLING ENTITY PRIOR TO THE PROCEDURE,
 TEST OR SURGERY, THAT AN OUT-OF-NETWORK PHYSICIAN MAY BE  USED  IN  SUCH
 PROCEDURE,  TEST  OR  SURGERY AND SUCH PHYSICIAN'S SERVICES SHALL NOT BE
 COVERED BY THEIR INSURANCE POLICY.
   (2) THE PATIENT COSTS OF OUT-OF-NETWORK PHYSICIAN  SERVICES  SHALL  BE
 COVERED  BY  THE  INSURANCE POLICY OF AN INSURED PERSON IF THEY HAVE NOT
 RECEIVED NOTIFICATION OF SUCH SITUATIONS, PRIOR TO THE HEALTH SERVICE OR
 PROCEDURE, AS PRESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION.
   § 2. Section 3221 of the insurance law is  amended  by  adding  a  new
 subsection (v) to read as follows:
   (V)  (1)  EVERY  PERSON  INSURED UNDER A POLICY OF ACCIDENT AND HEALTH
 INSURANCE DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE SHALL BE  ENTI-
 TLED  TO  NOTIFICATION  FROM  THE BILLING ENTITY PRIOR TO THE PROCEDURE,
 TEST OR SURGERY, THAT AN OUT-OF-NETWORK PHYSICIAN MAY BE  USED  IN  SUCH
 PROCEDURE,  TEST  OR  SURGERY AND SUCH PHYSICIAN'S SERVICES SHALL NOT BE
 COVERED BY THEIR INSURANCE POLICY.
   (2) THE PATIENT COSTS OF OUT-OF-NETWORK PHYSICIAN  SERVICES  SHALL  BE
 COVERED  BY  THE  INSURANCE POLICY OF AN INSURED PERSON IF THEY HAVE NOT
 RECEIVED NOTIFICATION OF SUCH SITUATIONS, PRIOR TO THE HEALTH SERVICE OR
 PROCEDURE, AS PRESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION.
   § 3. This act shall take effect immediately.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD07470-01-5