Requires insurance companies to disclose claims information to municipalities employing 400 or more employees to determine how their benefits are used; provides for imposition of a fine for failure to disclose such information in a timely manner.
STATE OF NEW YORK
________________________________________________________________________
1185--A
2015-2016 Regular Sessions
IN SENATE
January 9, 2015
___________
Introduced by Sen. LATIMER -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance -- recommitted
to the Committee on Insurance in accordance with Senate Rule 6, sec. 8
-- committee discharged, bill amended, ordered reprinted as amended
and recommitted to said committee
AN ACT to amend the insurance law, in relation to requiring insurance
companies to disclose claims information to municipalities
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The insurance law is amended by adding a new section 3217-i
2 to read as follows:
3 § 3217-i. Disclosure of information to municipalities. (a) Every
4 insurer contracting with municipalities employing four hundred or more
5 employees, including municipal cooperative health benefit plans certi-
6 fied pursuant to article forty-seven of this chapter, shall provide upon
7 request the following information to the insured municipality:
8 (1) specific claims experience covered by the insurer under a communi-
9 ty rated or experienced rated policy. For purposes of this section
10 "experience ratings" shall mean and include all quantitative measures
11 used by the insurance carrier such as expenses per member and any
12 historical data;
13 (2) average annual per member cost of claims reimbursement;
14 (3) number of members who did not file a claim within a twelve month
15 period;
16 (4) a comparison of emergency services used by members to out-patient
17 services;
18 (5) a loss ratio report;
19 (6) claims history for the last twelve months for experience rated
20 plans separated by medical and prescription;
21 (7) information regarding cost on the top twenty-five prescription
22 drugs being used by member employees;
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD02936-02-6
S. 1185--A 2
1 (8) large loss claims report indicating diagnosis and prognosis for
2 claims greater than thirty thousand dollars;
3 (9) medical loss ratio report; and
4 (10) any other statistical information the municipality requests to
5 determine use of benefits by members.
6 (b) The superintendent shall impose a fine of three hundred thousand
7 dollars for failure to provide within thirty days of a written request
8 by the insured municipality the information required by paragraph one of
9 subsection (a) of this section relating to how funding was spent by the
10 insurance carrier regarding the insured employees. A fine of ten thou-
11 sand dollars per day shall be imposed for each day such failure contin-
12 ues. Any fines imposed shall be paid to the insured municipality
13 requesting such information.
14 (c) Notwithstanding the foregoing provisions, in releasing any such
15 information the insurer shall comply with the federal health insurance
16 portability and accountability act (HIPAA) of 1996, as amended.
17 § 2. This act shall take effect immediately.
