Requires health insurers to provide health care providers with the coverage a policyholder or covered person has, when liability for a health care claim is not reasonably clear.
STATE OF NEW YORK
________________________________________________________________________
6341
2019-2020 Regular Sessions
IN SENATE
June 5, 2019
___________
Introduced by Sen. BRESLIN -- read twice and ordered printed, and when
printed to be committed to the Committee on Rules
AN ACT to amend the insurance law, in relation to requiring health
insurers to provide, when liability for a claim is not reasonably
clear, the coverage the policyholder or covered person is enrolled in
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph 2 of subsection (b) of section 3224-a of the
2 insurance law, as amended by chapter 237 of the laws of 2009, is amended
3 and a new paragraph 3 is added to read as follows:
4 (2) to request all additional information needed to determine liabil-
5 ity to pay the claim or make the health care payment[.]; and
6 (3) of the specific type of plan or product the policyholder or
7 covered person is enrolled in; provided that nothing in this section
8 shall authorize discrimination based on the source of payment.
9 § 2. Subsection (d) of section 3224-a of the insurance law is amended
10 by adding a new paragraph 3 to read as follows:
11 (3) "plan or product" shall mean:
12 (i) medicaid coverage certified pursuant to section three hundred
13 sixty-four-j of the social services law;
14 (ii) a child health insurance plan certified pursuant to section twen-
15 ty-five hundred eleven of the public health law;
16 (iii) basic health program coverage certified pursuant to section
17 three hundred sixty-nine-gg of the social services law, including the
18 specific rating group the policyholder or covered person is enrolled in;
19 (iv) coverage purchased on the New York insurance exchange established
20 pursuant to article sixty-two of this chapter; and
21 (v) any other product fully insured and regulated by the state under
22 article forty-two, forty-three, or forty-seven of this chapter, or arti-
23 cle forty-four of the public health law.
24 § 3. This act shall take effect July 1, 2020.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13221-01-9
