What's happening
This bill requires health insurers to inform policyholders of their specific type of health plan when a claim's liability is unclear.
Why it matters
Increases transparency for patients. By requiring insurers to specify the type of health plan or product when claim liability is unclear, patients and providers will better understand coverage details, which can affect care decisions, billing, and dispute resolution.
Clarifies distinctions between coverage types. The bill mandates insurers specify whether the coverage is Medicaid, Child Health Plus, Basic Health Program, an exchange-purchased plan, or another state-regulated product—helping patients and providers navigate complex rules and eligibility linked to each type.
Protects against discrimination. The bill explicitly prohibits insurers from using plan type information to discriminate based on the source of payment, addressing concerns that disclosure could lead to unfair treatment of those with public or subsidized coverage.
Could reduce administrative delays. By making plan type information readily available during claim disputes, the bill aims to streamline claim processing and appeals, potentially reducing administrative burdens and resolution times for both patients and providers.
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Who cares
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Insurers Must Disclose Coverage Details
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Recommitted to rules
- Ordered to third reading cal.2213
- Committee discharged and committed to rules
- Print number 5779a
- 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
Assembly Floor Calendar · Sponsor Steven Cymbrowitz
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
5779--A
2017-2018 Regular Sessions
IN SENATE
April 28, 2017
Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed 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
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11297-03-7
S. 5779--A 2
(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.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
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
Purpose
The require plans to clearly identify to a provider the product an individual is enrolled in for health coverage purposes.
Summary of provisions
Section 1 amends subsection (b) of paragraph (2) of section 3224-a of the Insurance Law to add a new requirement that an insurer identify the specific type of plan or product the policy-holder or covered person is enrolled in.
Section 2 amends subsection (d) of section 3224-a of the Insurance law to add a new paragraph 3 to define the plans or products that must be identified by the insurer.
Section 3 provides that this act shall take effect July 1, 2018.
Justification
Hospitals and health care providers are currently challenged with identifying which specific health plan a patient is enrolled in. Health plans today offer a wide variety of products, which can make it very difficult to identify what particular health coverage a patient has. There is no requirement for plans to consistently and uniformly identify what particular product an individual is enrolled in.
The current inability to identify these products or the regulatory rules that apply causes providers, regulators, and plans to waste valuable resources appealing, communicating, and replacing claims incorrectly or when it is not necessary. Under the current system, identification of the type of coverage is ultimately made after an appeal is submitted by a patient or a provider and after these resources have already been wasted.
This bill would ensure plans provide the necessary information at the time the plan makes a payment determination. This will avoid wasting time and energy on filing unnecessary appeals and identify protections available for patients based on their particular coverage by ensuring clear and consistent information about the particular product a patient is enrolled in.
Legislative history
2016: S.7370
Fiscal implications
None
Effective date
July 1, 2018
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.