§ 4306-c. Grievance procedure and access to specialty care. (a) A
corporation, including a municipal cooperative health benefits plan
certified pursuant to article forty-seven of this chapter, that issues a
comprehensive contract that utilizes a network of providers and is not a
managed care health insurance contract as defined in subsection (c) of
section four thousand eight hundred one of this chapter shall establish
and maintain a grievance procedure consistent with the requirements of
section four thousand eight hundred two of this chapter.

(b) A corporation, including a municipal cooperative health benefits
plan certified pursuant to article forty-seven of this chapter, that
issues a comprehensive contract that utilizes a network of providers and
is not a managed care health insurance contract as defined in subsection
(c) of section four thousand eight hundred one of this chapter and
requires that specialty care be provided pursuant to a referral from a
primary care provider shall provide access to such specialty care
consistent with the requirements of subsections (b), (c) and (d) of
section four thousand eight hundred four of this chapter; provided
however, that nothing in this section shall be construed to require that
a corporation, or a primary care provider on behalf of the corporation,
make a referral to a provider that is not in the corporation's network.

(c) A corporation, including a municipal cooperative health benefits
plan certified pursuant to article forty-seven of this chapter, that
issues a comprehensive contract that utilizes a network of providers and
is not a managed care health insurance contract as defined in subsection
(c) of section four thousand eight hundred one of this chapter shall
provide access to transitional care consistent with the requirements of
subsections (e) and (f) of section four thousand eight hundred four of
this chapter.

(d) A corporation, including a municipal cooperative health benefit
plan certified pursuant to article forty-seven of this chapter and a
student health plan established or maintained pursuant to section one
thousand one hundred twenty-four of this chapter, that issues a
comprehensive policy that utilizes a network of providers and is not a
managed care health insurance contract as defined in subsection (c) of
section four thousand eight hundred one of this chapter, shall provide
access to out-of-network services consistent with the requirements of
subsection (a) of section four thousand eight hundred four of this
chapter, subsections (g-6) and (g-7) of section four thousand nine
hundred of this chapter, subsections (a-1) and (a-2) of section four
thousand nine hundred four of this chapter, paragraphs three and four of
subsection (b) of section four thousand nine hundred ten of this
chapter, and subparagraphs (C) and (D) of paragraph four of subsection
(b) of section four thousand nine hundred fourteen of this chapter.

(e) A corporation, including a municipal cooperative health benefit
plan certified pursuant to article forty-seven of this chapter and a
student health plan established or maintained pursuant to section one
thousand one hundred twenty-four of this chapter as added by chapter 246
of the laws of 2012, that issues a comprehensive policy that uses a
network of providers and is not a managed care health insurance
contract, as defined in subsection (c) of section four thousand eight
hundred one of this chapter, shall establish and maintain procedures for
health care professional applications and terminations consistent with
the requirements of section four thousand eight hundred three of this
chapter and procedures for health care facility applications consistent
with section four thousand eight hundred six of this chapter.