Buttenschon, Davila, Glick, Griffin, Hyndman, Rosenthal, Simon
Amd §§3217-a & 4324, Ins L; amd §4408, Pub Health L
Requires insurer to respond within thirty days of a written request from an insured for their health plan documents, including copies of most recent group or individual contracts.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A4776
SPONSOR: Cook (MS) 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:
2023-2024: S5592 Comrie/ A.5957 Cook
2021-2022: S5529 Comrie/ A.3433 Cook Previously Introduced;
2017/18 A.2054
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.
STATE OF NEW YORK
________________________________________________________________________
4776
2025-2026 Regular Sessions
IN ASSEMBLY
February 6, 2025
___________
Introduced by M. of A. COOK, PEOPLES-STOKES, TAYLOR, BICHOTTE HERMELYN,
SAYEGH, EPSTEIN, COLTON, STECK -- Multi-Sponsored by -- M. of A.
BUTTENSCHON, DAVILA, GLICK, GRIFFIN, HYNDMAN, ROSENTHAL, SIMON -- read
once and referred to the Committee on Insurance
AN ACT to amend the insurance law and the public health law, in relation
to disclosure and access to health insurance plan documents
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph 3 of subsection (b) of section 3217-a of the
2 insurance law, as added by chapter 705 of the laws of 1996, is amended
3 to read as follows:
4 (3) provide a copy of the most recent individual, direct pay subscrib-
5 er contracts and, upon the written request of an individual covered
6 under a group contract which was the subject of collective bargaining,
7 provide a copy of such contract within thirty days of the receipt of
8 such request;
9 § 2. Paragraph 3 of subsection (b) of section 4324 of the insurance
10 law, as added by chapter 705 of the laws of 1996, is amended to read as
11 follows:
12 (3) provide a copy of the most recent individual, direct pay subscrib-
13 er contracts and, upon the written request of an individual covered
14 under a group contract which was the subject of collective bargaining,
15 provide a copy of such contract within thirty days of the receipt of
16 such request;
17 § 3. Paragraph (c) of subdivision 2 of section 4408 of the public
18 health law, as added by chapter 705 of the laws of 1996, is amended to
19 read as follows:
20 (c) provide a copy of the most recent individual, direct pay subscrib-
21 er contracts and, upon the written request of an individual covered
22 under a group contract which was the subject of collective bargaining,
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD05807-01-5
A. 4776 2
1 provide a copy of such contract within thirty days of the receipt of
2 such request;
3 § 4. This act shall take effect on the sixtieth day after it shall
4 have become a law.
