Directs a health maintenance organization which denies a claim due to absence of medical necessity to inform the insured as to preferred alternative treatment, or provide the insured with a statement as to the past ineffectiveness of the requested procedure or treatment.
STATE OF NEW YORK
________________________________________________________________________
7292
2025-2026 Regular Sessions
IN ASSEMBLY
March 25, 2025
___________
Introduced by M. of A. PRETLOW -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the insurance law, in relation to notice by health main-
tenance organizations that a request for coverage of a particular
treatment is denied
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 2601-a
2 to read as follows:
3 § 2601-a. Denial of coverage or treatment by a health maintenance
4 organization. Whenever a health maintenance organization, doing business
5 in this state, denies a claim for coverage of a particular procedure or
6 treatment because such procedure or treatment is not medically neces-
7 sary, the health maintenance organization shall inform the insured as to
8 those preferred procedure or treatment options which would be covered,
9 or provide the insured with a statement as to the past ineffectiveness
10 of the requested procedure or treatment.
11 § 2. This act shall take effect on the thirtieth day after it shall
12 have become a law.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11000-01-5
