Requires notification to insureds that an out-of-network physician may be used in their procedure, test or surgery and such physician's services shall not be covered by their insurance policy; provides such services must be covered if the insured person does not receive notification prior to such services or procedure.
STATE OF NEW YORK
________________________________________________________________________
3488
2025-2026 Regular Sessions
IN ASSEMBLY
January 28, 2025
___________
Introduced by M. of A. DILAN -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to requiring notification
to insured persons that an out-of-network physician may be used in
their procedure, test or surgery
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 3216 of the insurance law is amended by adding a
2 new subsection (n) to read as follows:
3 (n) (1) Every person insured under a policy of accident and health
4 insurance delivered or issued for delivery in this state shall be enti-
5 tled to notification from the billing entity prior to the procedure,
6 test or surgery, that an out-of-network physician may be used in such
7 procedure, test or surgery and such physician's services shall not be
8 covered by their insurance policy.
9 (2) The patient costs of out-of-network physician services shall be
10 covered by the insurance policy of an insured person if they have not
11 received notification of such situations, prior to the health service or
12 procedure, as prescribed in paragraph one of this subsection.
13 § 2. Section 3221 of the insurance law is amended by adding a new
14 subsection (v) to read as follows:
15 (v) (1) Every person insured under a policy of accident and health
16 insurance delivered or issued for delivery in this state shall be enti-
17 tled to notification from the billing entity prior to the procedure,
18 test or surgery, that an out-of-network physician may be used in such
19 procedure, test or surgery and such physician's services shall not be
20 covered by their insurance policy.
21 (2) The patient costs of out-of-network physician services shall be
22 covered by the insurance policy of an insured person if they have not
23 received notification of such situations, prior to the health service or
24 procedure, as prescribed in paragraph one of this subsection.
25 § 3. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD07470-01-5
