What's happening
The New York State of Health Transparency Act requires health plans to clearly disclose key coverage details and costs on the state marketplace.
Why it matters
Empowers consumers to make better health plan choices. by requiring clear information about which doctors, hospitals, and drugs are covered—helping avoid costly surprises or denied care after enrollment.
Improves understanding of out-of-pocket costs. by mandating up-front disclosure of copay, coinsurance, deductibles, and any limits or exclusions—enabling more accurate budgeting for healthcare expenses.
Enhances patient protections and appeals transparency. by requiring clear explanations of how to challenge denied claims and what rights patients have when necessary care is not initially covered, especially for out-of-network or non-covered services.
Addresses medication access and costs. by obligating insurers to state if and how specific drugs are covered, any prerequisites or authorizations required, and whether costs count toward the deductible—reducing confusion and barriers to needed prescriptions.
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Who cares
Consumers shopping on the health insurance marketplace
The bill would require clear information to compare plans’ provider networks, coverage restrictions, copays and coinsurance.
Health insurers offering marketplace plans
Their plans’ drug formularies, deductible rules, authorization requirements and denial reversal procedures would have to be available to consumers on the marketplace.
Patients who need prescription drugs
Consumers would be able to check whether a specific drug is covered, its cost-sharing requirements and any clinical prerequisites for coverage.
Physicians, hospitals and other providers
Consumers would be able to check whether named providers are in-network and review coverage and appeal rights for medically necessary out-of-network care.
Headline styles
Make Health Plans Transparent
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Held for consideration in health
- Referred to health
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
10033
IN ASSEMBLY
March 4, 2020
Introduced by M. of A. BYRNE -- read once and referred to the Committee on Health
AN ACT to amend the public health law, in relation to the New York state of health transparency act
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. This act shall be known and may be cited as the "New York State of Health Transparency Act".
§ 2. Section 268-h of the public health law is renumbered section 268-i and a new section 268-h is added to read as follows:
§ 268-h. Marketplace transparency. The following information about each health plan offered for sale to consumers shall be available to consumers on the marketplace in a clear and understandable form for use in comparing plans, plan coverage, and plan premiums:
1. the ability to determine whether specific types of health care practitioners are in-network and to determine whether a named health care practitioner, hospital, or other provider is in network;
2. any exclusions from coverage and any restrictions on use or quantity of covered items and services in each category of benefits;
3. a description of how medications will specifically be included in or excluded from the deductible, including a description of out-of-pocket costs that may not apply to the deductible for a medication;
4. the specific dollar amount of any copay or percentage of coinsurance for each item or service;
5. the ability to determine whether a specific drug is available on formulary, the applicable cost-sharing requirement, whether a specific drug is covered when furnished by a physician or clinic and any clinical prerequisites or authorization requirements for coverage of a drug;
6. the process for a patient to obtain reversal of a health plan decision where an item or service prescribed or ordered by the treating physician has been denied; and
7. an explanation of the amount of coverage for out-of-network providers or non-covered services, and any rights of appeal that exist when
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD15256-01-0
A. 10033 2
out-of-network providers or non-covered services are medically necessary.
§ 3. Severability clause. If any clause, sentence, paragraph, subdivision, or section of this act shall be adjudged by any court of competent jurisdiction to be invalid, such judgment shall not affect, impair, or invalidate the remainder thereof, but shall be confined in its operation to the clause, sentence, paragraph, subdivision, or section thereof directly involved in the controversy in which such judgment shall have been rendered. It is hereby declared to be the intent of the legislature that this act would have been enacted even if such invalid provisions had not been included herein.
§ 4. This act shall take effect one year after it shall have become a law.
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.