What's happening
This bill requires health insurers and HMOs in New York to offer optional out-of-network coverage both inside and outside the health benefit exchange.
Why it matters
Expands consumer choice. By requiring all health insurers and HMOs to offer out-of-network coverage as an option, the bill gives consumers more flexibility to see providers who are not in their plan’s network—potentially important for those with established relationships or specialized care needs.
Market impact and premiums. Mandating out-of-network options could impact insurance pricing and plan design, possibly leading to higher premiums for plans that include this broader coverage, but also addressing a major consumer pain point about network restrictions.
Parity inside and outside the exchange. The bill ensures that people purchasing insurance both on the New York State of Health exchange and directly from insurers have access to plans with out-of-network options, which could help prevent disparities between different segments of the insurance market.
Potential for improved access and reduced surprise bills. With more widespread availability of out-of-network coverage, consumers faced with emergencies or limited in-network choices may have better access to care and more protection against unexpected medical bills.
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Who cares
Headline styles
Require Out-of-Network Coverage
Plain English, a few words. Used as the page title.
Sponsors
3 Multi-sponsors
History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
434
2017-2018 Regular Sessions
IN ASSEMBLY
January 9, 2017
Introduced by M. of A. ROSENTHAL, THIELE, GALEF, SKOUFIS, SEPULVEDA, STECK, ZEBROWSKI -- Multi-Sponsored by -- M. of A. LUPINACCI, SIMON, SKARTADOS -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law and the public health law, in relation to requiring health care insurers to offer coverage for health care provided by out-of-network providers
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 3217-e of the insurance law, as added by chapter 219 of the laws of 2011, is amended to read as follows:
§ 3217-e. Choice of health care provider. (a) An insurer that is subject to this article and requires or provides for designation by an insured of a participating primary care provider shall permit the insured to designate any participating primary care provider who is available to accept such individual, and in the case of a child, shall permit the insured to designate a physician (allopathic or osteopathic) who specializes in pediatrics as the child's primary care provider if such provider participates in the network of the insurer.
(b) Every insurer that offers health insurance and is subject to the provisions of this article, shall offer out-of-network coverage as an optional rider to any policy and shall offer at least one policy option that includes out-of-network coverage. These options shall be made available both within the statewide health benefit exchange and outside of the health benefit exchange.
§ 2. Section 4306-d of the insurance law, as added by chapter 219 of the laws of 2011, is amended to read as follows:
§ 4306-d. Choice of health care provider. (a) A corporation that is subject to the provisions of this article and requires or provides for designation by a subscriber of a participating primary care provider shall permit the subscriber to designate any participating primary care provider who is available to accept such individual, and in the case of
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01720-01-7
A. 434 2
a child, shall permit the subscriber to designate a physician (allopathic or osteopathic) who specializes in pediatrics as the child's primary care provider if such provider participates in the network of the corporation.
(b) Every corporation that is subject to the provisions of this article, shall offer out-of-network coverage as an optional rider to any contract and shall offer at least one contract option that includes out-of-network coverage. These options shall be made available both within the statewide health benefit exchange and outside of the health benefit exchange.
§ 3. Section 4403 of the public health law is amended by adding a new subdivision 9 to read as follows:
9. Every health maintenance organization shall offer out-of-network coverage as an optional rider to any contract and shall offer at least one contract option that includes out-of-network coverage. These options shall be made available both within the statewide health benefit exchange and outside of the health benefit exchange.
§ 4. 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 contracts and policies issued, renewed, modified or amended on or after such date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.