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A08500 Summary:

BILL NOA08500
 
SAME ASSAME AS S04122
 
SPONSORPheffer Amato
 
COSPNSR
 
MLTSPNSR
 
Amd §§162 & 161-a, Civ Serv L
 
Clarifies that the New York state health insurance program remains subject to certain provisions of the financial services law and coverage for usual and customary costs for out-of-network health care service.
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A08500 Actions:

BILL NOA08500
 
05/20/2025referred to governmental employees
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A08500 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          8500
 
                               2025-2026 Regular Sessions
 
                   IN ASSEMBLY
 
                                      May 20, 2025
                                       ___________
 
        Introduced  by  M.  of A. PHEFFER AMATO -- read once and referred to the
          Committee on Governmental Employees
 
        AN ACT to amend the civil service law, in relation  to  clarifying  that
          the New York state health insurance program remains subject to certain
          provisions of the financial services law

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Subparagraph (i) of  paragraph  (b)  of  subdivision  1  of
     2  section  162 of the civil service law, as amended by section 3 of part T
     3  of chapter 56 of the laws of 2010, is amended to read as follows:
     4    (i) Any and all health insurance coverage mandated by any law, rule or
     5  regulation, including but not limited to coverage mandated  pursuant  to
     6  article  forty-three  of  the insurance law, applicable to contracts for
     7  health insurance entered into under this section shall be provided in  a
     8  manner  assuring  uninterrupted  continuance of coverage for all covered
     9  persons. Health benefits shall include a requirement that covered health
    10  care services provided to plan participants will be  reimbursed  at  the
    11  level of at least eighty percent of the usual and customary cost of each
    12  out-of-network  health    care  service.  As  used in this subparagraph,
    13  "usual and customary cost" shall mean the eightieth  percentile  of  all
    14  charges  for  the particular health care service performed by a provider
    15  in the same or similar specialty and provided in the  same  geographical
    16  area  as  reported  in a benchmarking database maintained by a nonprofit
    17  organization specified by the superintendent of financial services.  For
    18  the purposes of this paragraph "coverage" shall include but shall not be
    19  limited  to  all  benefits,  services, rights, privileges and guarantees
    20  allowed by law;
    21    § 2. Subdivision 1 of section 161-a  of  the  civil  service  law,  as
    22  amended  by  section  10 of part T of chapter 56 of the laws of 2010, is
    23  amended to read as follows:
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD06196-01-5

        A. 8500                             2
 
     1    1. Where, and to the extent that, an agreement between the  state  and
     2  an  employee  organization  entered into pursuant to article fourteen of
     3  this chapter provides for health benefits, the president, after  receipt
     4  of  written  directions  from  the director of employee relations, shall
     5  implement  the  provisions  of  such agreement consistent with the terms
     6  thereof and to the extent necessary shall  adopt  regulations  providing
     7  for  the  benefits  to  be  thereunder provided. The president, with the
     8  approval of the director of the budget, may  extend  such  benefits,  in
     9  whole  or in part, provided that such benefits are not a diminishment of
    10  current existing benefits to employees not subject to the provisions  of
    11  such agreement.
    12    § 3. This act shall take effect immediately.
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