What's happening
This bill requires insurance companies to provide detailed claims data to municipalities with 400 or more employees upon request, with fines for noncompliance.
Why it matters
Empowers large municipalities (400+ employees) to demand detailed claims data from insurers. , including specifics like average claim costs, member utilization patterns, high-cost claims, and the most expensive prescription drugs—enabling local governments to scrutinize how public funds are spent on employee benefits.
Introduces significant financial penalties for insurer non-compliance—$300,000 plus $10,000 per day for delays—. which creates a strong incentive for insurance carriers to be transparent and timely in their disclosures, effectively shifting leverage toward municipalities in contract negotiations.
Facilitates more informed decision-making by municipalities on health benefit plans,. potentially leading to cost savings, better plan design, and improved accountability in the management of taxpayer-funded employee benefits.
Requires compliance with HIPAA privacy protections. when releasing data, balancing transparency with the need to safeguard individual health information, and ensuring municipalities receive actionable information without violating federal privacy laws.
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Who cares
Headline styles
Reveal Insurance Claims to Cities
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2826
2019-2020 Regular Sessions
IN ASSEMBLY
January 25, 2019
Introduced by M. of A. ZEBROWSKI -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to requiring insurance companies to disclose claims information to municipalities
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. The insurance law is amended by adding a new section 3217-i to read as follows:
§ 3217-i. Disclosure of information to municipalities. (a) Every insurer contracting with municipalities employing four hundred or more employees, including municipal cooperative health benefit plans certified pursuant to article forty-seven of this chapter, shall provide upon request the following information to the insured municipality:
(1) specific claims experience covered by the insurer under a community rated or experienced rated policy. For purposes of this section "experience ratings" shall mean and include all quantitative measures used by the insurance carrier such as expenses per member and any historical data;
(2) average annual per member cost of claims reimbursement;
(3) number of members who did not file a claim within a twelve month period;
(4) a comparison of emergency services used by members to out-patient services;
(5) a loss ratio report;
(6) claims history for the last twelve months for experience rated plans separated by medical and prescription;
(7) information regarding cost on the top twenty-five prescription drugs being used by member employees;
(8) large loss claims report indicating diagnosis and prognosis for claims greater than thirty thousand dollars;
(9) medical loss ratio report; and
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02147-01-9
A. 2826 2
(10) any other statistical information the municipality requests to determine use of benefits by members.
(b) The superintendent shall impose a fine of three hundred thousand dollars for failure to provide within thirty days of a written request by the insured municipality the information required by paragraph one of subsection (a) of this section relating to how funding was spent by the insurance carrier regarding the insured employees. A fine of ten thousand dollars per day shall be imposed for each day such failure continues. Any fines imposed shall be paid to the insured municipality requesting such information.
(c) Notwithstanding the foregoing provisions, in releasing any such information the insurer shall comply with the federal health insurance portability and accountability act (HIPAA) of 1996, as amended.
§ 2. This act shall take effect immediately.
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.