•  Summary 
  •  
  •  Actions 
  •  
  •  Committee Votes 
  •  
  •  Floor Votes 
  •  
  •  Memo 
  •  
  •  Text 

A03734 Summary:

BILL NOA03734
 
SAME ASSAME AS S01846
 
SPONSORRosenthal
 
COSPNSRLavine, Thiele, Galef, Schimel, Skoufis, Sepulveda, Steck, Zebrowski
 
MLTSPNSRBrennan, Lupinacci, Simon, Skartados
 
Amd SS3217-e & 4306-d, Ins L; amd S4403, Pub Health L
 
Requires health insurers to offer coverage of health care provided by out-of-network providers.
Go to top

A03734 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A3734
 
SPONSOR: Rosenthal (MS)
  TITLE OF BILL: An act to amend the public health law and the insurance law, in relation to requiring health care insurers to offer coverage for health care provided by out-of-network providers   PURPOSE: Ensures consumer choice by providing for continued access to out-of-net- work insurance coverage   SUMMARY OF PROVISIONS: This bill amends Public Health Law § 4403 and Insurance Law §§ 3217-e and 4306-d to require that every insurer offer, both inside and outside of the exchange, out-of-network coverage in at least one policy option and as an optional rider. It provides an effective date of January 1st next succeeding the date of enactment.   JUSTIFICATION: Across the state, individuals accessing insurance through the statewide health benefit exchange, "the New York State of Health," and outside of the exchange are finding plans no longer include out-of-network cover- age, Citing concerns of keeping plan costs affordable and predictable, the New York State of Health did not require plans sold on the exchange offer out-of-network coverage. In establishing the New York State of Health, the only condition regulators imposed on insurers regarding out-of-network coverage was the requirement that if they offer out-of- network coverage to individuals purchasing insurance directly, they must also offer it through the exchange. As insurance carriers put into effect cost saving measures, coverage the Affordable Care Act does not mandate, such as out-of-network coverage, is being eliminated. Insurers across the state faced concerns that competitors would not offer out-of-network coverage, leaving them to attract the sickest, most costly patients if they did offer this cover- age. The result has been most insurers chose to eliminate the out-of- network option in all their plans marketed to individuals. This coverage remains an option in just 8 counties in the state, all in Western New York. Some New Yorkers who previously had out-of-network coverage on the individual market are allowed to keep it through riders on their policy; however, other individuals are not eligible to purchase such riders. This situation is compounded by recent reports that the plans being offered on the exchange have very limited networks. The Wall Street Journal reported results of a McKinsey report which looked at federal and state-run exchanges in 20 cities, finding that 60 of health plans offered coverage at fewer hospitals compared to current individual plans. Narrow networks restrict access and further illustrate the need for an out-of-network coverage option. While policies containing out-of-network coverage will likely cost more than those that do not provide this coverage, for individuals facing certain illnesses or having specific health care needs, this is an affordable and necessary option that must be made available. Addi- tionally, for individuals who have used a particular provider not included within a network, this added option may be well worth the extra expense. By requiring insurers to provide out-of-network coverage as an option, this legislation will provide and protect consumer choice, and ensure patients can maintain access to the provider of their choice.   LEGISLATIVE HISTORY: A.8494 of 2013-2014   FISCAL IMPLICATIONS: None.   EFFECTIVE DATE: The first of January next succeeding the date on which it shall become law, and shall apply to contracts and policies issued, renewed, modified or amended on or after such date.
Go to top