Provides for out-of-network coverage for flu shots

BILL NUMBER:S3856

Title of bill

An act to amend the insurance law, in relation to insurance coverage for out-of-network flu shots

Purpose

To prohibit insurance policies from denying coverage for individuals who receive a flu shot from an out-of-network provider.

Summary of provisions

Section 1 adds out-of-network flu shot coverage to the list of entitled reimbursements and coverages for every person insured under accident and health insurance in this state.

Section 2 adds out-of-network flu shot coverage to the list of standard provisions for group or blanket accident and health insurance policies.

Section 3 adds out-of-network flu shot coverage to the list of required benefits of non-profit medical and dental indemnity or health and hospital service corporations.

Section 4 adds flu shots to the list of in-plan and out-of-plan covered services for the standardized individual enrollee direct payment contract.

Section 5 provides that the effective date is on the first of January next succeeding the date on which it shall have become a law.

Justification

The flu season, which lasts from roughly October through May, increasingly threatens the health of New Yorkers. This year the Governor declared a "state of emergency" as the total number of cases soared to roughly 20,000 people, five times the number of last season. Around 3,000 of these cases required hospitalization and two people died.

This epidemic is easily avoidable with the flu vaccine ("flu shot"), which reduces the adds of infection by 70% to 90%. Flu shots are widely available through physicians and at many local pharmacies. Unfortunately, many health insurance companies limit coverage to only in-network providers, substantially inhibiting the ability of many New Yorkers to take this important preventative measure due to expense and/or inconvenience.

The bill increases access to the flu vaccine by requiring health insurers to cover flu shots from both in-network and out-of-network providers, thus protecting the health of New Yorkers.

Legislative history

None.

Fiscal implications

None.

Effective date

This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply to insurance policies and contracts issued, renewed, modified or altered on or after such effective date.