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A07671 Summary:

BILL NOA07671
 
SAME ASSAME AS S05675
 
SPONSORRosenthal
 
COSPNSRJaffee, Steck, Brindisi, Fahy, Sepulveda, Jean-Pierre
 
MLTSPNSR
 
Amd 3217-e & 4306-d, Ins L; amd 4403, Pub Health L
 
Requires health insurers to offer coverage of health care provided by out-of-network providers.
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A07671 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A7671
 
SPONSOR: Rosenthal
  TITLE OF BILL: An act to amend the public health law and the insur- ance law, in relation to requiring health care insurers to offer cover- age 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 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. Rather, 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. While the Department of Health had indicated that the 2015 exchange invitation would include a requirement for out-of-network benefits, the final invitation did not include such requirement. Instead the 2015 invitation continued the requirement that if the applicant offered an out-of-network product outside of the exchange, it must also offer such within the exchange at platinum and silver levels. Further, the invitation encouraged insurers to offer such products within the exchange if they do not offer such outside of 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 a handful of counties in the state. 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 the 2014-15 Budget did include monumental changes protecting consumers from surprise medical bills resulting from out-of-network care, those provisions did not address access to out-of-network coverage in the individual market. 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 affordable and necessary option that must be made available. Additionally, for individuals who previously sought care by a particular provider no longer included within their 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: This is a new bill.   FISCAL IMPLICATIONS: None to the State.   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.
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A07671 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          7671
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                       May 8, 2017
                                       ___________
 
        Introduced  by  M.  of  A.  ROSENTHAL  --  read once and referred to the
          Committee on Insurance
 
        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

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1.  Section 4403 of the public health law is amended by adding
     2  a new subdivision 9 to read as follows:
     3    9. Every health maintenance organization  shall  offer  out-of-network
     4  coverage  as  an optional rider to any contract and shall offer at least
     5  one contract option that includes out-of-network coverage. These options
     6  shall be  made  available  both  within  the  statewide  health  benefit
     7  exchange and outside of the health benefit exchange.
     8    §  2.  Section 3217-e of the insurance law, as added by chapter 219 of
     9  the laws of 2011, is amended to read as follows:
    10    § 3217-e. Choice of health care  provider.  (a)  An  insurer  that  is
    11  subject  to  this article and requires or provides for designation by an
    12  insured of a  participating  primary  care  provider  shall  permit  the
    13  insured  to  designate  any  participating  primary care provider who is
    14  available to accept such individual, and in the case of a  child,  shall
    15  permit  the insured to designate a physician (allopathic or osteopathic)
    16  who specializes in pediatrics as the child's primary  care  provider  if
    17  such provider participates in the network of the insurer.
    18    (b)  Every  insurer that offers health insurance and is subject to the
    19  provisions of this article, shall offer out-of-network  coverage  as  an
    20  optional  rider to any policy and shall offer at least one policy option
    21  that includes out-of-network  coverage.  These  options  shall  be  made
    22  available  both within the statewide health benefit exchange and outside
    23  of the health benefit exchange.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01720-02-7

        A. 7671                             2
 
     1    § 3. Section 4306-d of the insurance law, as added by chapter  219  of
     2  the laws of 2011, is amended to read as follows:
     3    §  4306-d.  Choice  of health care provider. (a) A corporation that is
     4  subject to the provisions of this article and requires or  provides  for
     5  designation  by  a  subscriber  of a participating primary care provider
     6  shall permit the subscriber to designate any participating primary  care
     7  provider  who is available to accept such individual, and in the case of
     8  a child, shall permit the subscriber to designate a physician (allopath-
     9  ic or osteopathic) who specializes in pediatrics as the child's  primary
    10  care provider if such provider participates in the network of the corpo-
    11  ration.
    12    (b)  Every corporation that is subject to the provisions of this arti-
    13  cle, shall offer out-of-network coverage as an  optional  rider  to  any
    14  contract  and  shall  offer  at  least one contract option that includes
    15  out-of-network coverage. These options  shall  be  made  available  both
    16  within  the  statewide health benefit exchange and outside of the health
    17  benefit exchange.
    18    § 4. This act shall take effect on the first of January next  succeed-
    19  ing  the  date  on  which it shall have become a law, and shall apply to
    20  contracts and policies issued, renewed, modified or amended on or  after
    21  such date.
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