What's happening
This bill requires health insurers to disclose the specific type of plan or product a policyholder is enrolled in when a claim's liability is unclear.
Why it matters
Increased transparency for consumers and providers. The bill would require health insurers to disclose not only whether a person is covered, but specifically which type of insurance plan or product (e.g., Medicaid, Child Health Plus, marketplace plan) they are enrolled in when there's uncertainty about claim payment, helping patients and healthcare providers understand coverage details sooner.
Reduces administrative delays and confusion. By mandating insurers specify the exact plan type, the bill aims to speed up the claims process and reduce miscommunication that can lead to delayed payments, billing errors, or inappropriate denials of care.
Broad definition covers most major health plans. The bill defines “plan or product” to include Medicaid, Child Health Plus, Essential Plan, marketplace plans, and other insured products regulated by the state, ensuring comprehensive applicability across New York’s insurance landscape.
Anti-discrimination protection. The bill explicitly bars insurers from using the disclosed source of payment (such as Medicaid or a marketplace plan) to discriminate against patients, addressing concerns about potential bias in access to care or claims processing.
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Who cares
Health insurers
When liability for a claim is not reasonably clear, they would have to identify the specific plan or product covering the policyholder or covered person.
Health care providers
They would receive coverage details from insurers when claim liability is unclear, including the enrollee’s specific rating group for basic health program coverage.
Medicaid, child health insurance and exchange enrollees
Their coverage types are expressly included in the disclosure requirement, which would not authorize discrimination based on the source of payment.
Headline styles
Insurers Must Disclose Coverage
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Ordered to third reading cal.577
- Ordered to third reading rules cal.620
- Rules report cal.620
- Reported
- Reported referred to rules
- Print number 8063a
- Amend and recommit to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Insurers Must Disclose Coverage Details
In Senate Committee · Insurance · Sponsor Kemp Hannon
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
8063--A
2017-2018 Regular Sessions
IN ASSEMBLY
May 25, 2017
Introduced by M. of A. CYMBROWITZ -- read once and referred to the Committee on Insurance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee
AN ACT to amend the insurance law, in relation to requiring health insurers to provide, when liability for a claim is not reasonably clear, the coverage the policyholder or covered person is enrolled in
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph 2 of subsection (b) of section 3224-a of the insurance law, as amended by chapter 237 of the laws of 2009, is amended and a new paragraph 3 is added to read as follows:
(2) to request all additional information needed to determine liability to pay the claim or make the health care payment[.]; and
(3) of the specific type of plan or product the policyholder or covered person is enrolled in; provided that nothing in this section shall authorize discrimination based on the source of payment.
§ 2. Subsection (d) of section 3224-a of the insurance law is amended by adding a new paragraph 3 to read as follows:
(3) "plan or product" shall mean:
(i) medicaid coverage certified pursuant to section three hundred sixty-four-j of the social services law;
(ii) a child health insurance plan certified pursuant to section twenty-five hundred eleven of the public health law;
(iii) basic health program coverage certified pursuant to section three hundred sixty-nine-gg of the social services law, including the specific rating group the policyholder or covered person is enrolled in;
(iv) coverage purchased on the New York insurance exchange established pursuant to article sixty-two of this chapter; and
(v) any other product fully insured and regulated by the state under article forty-two, forty-three, or forty-seven of this chapter, or article forty-four of the public health law.
§ 3. This act shall take effect July 1, 2018.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11297-02-7
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.