What's happening
This bill requires New York to designate an independent consumer assistance program to help residents with health insurance issues and mandates health plans to provide program contact information.
Why it matters
Empowers consumers to navigate complex insurance issues. By establishing an independent consumer assistance program, the bill aims to help New Yorkers file complaints and appeals, including both internal and external processes, making it easier for residents to challenge denied claims or resolve disputes with their health plans.
Addresses gaps in access and financial assistance. The program is tasked with aiding uninsured, insured, or underinsured individuals not only in understanding their rights but also in accessing care, hospital financial aid, and resolving medical billing issues, which could be especially important for vulnerable populations facing barriers to care.
Promotes transparency and accountability in health plans. By requiring health insurers to prominently display the contact information for the assistance program on key consumer documents (like denial letters and member handbooks), the bill makes it more likely that consumers will know where to turn for help, potentially leading to greater insurer accountability.
Creates a feedback loop for systemic improvement. The program’s mandate to collect, track, and quantify consumer issues can provide regulators and policymakers with valuable data about recurring problems in the health insurance market, laying the groundwork for future reforms and more responsive oversight.
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Who cares
Headline styles
Create Consumer Assistance Program
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred 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.
Help For Insurance Consumers
In Senate Committee · Rules · Sponsor Gustavo Rivera
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
7754
2019-2020 Regular Sessions
IN ASSEMBLY
May 20, 2019
Introduced by M. of A. GOTTFRIED -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to the designation of an independent consumer assistance program
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 211 to read as follows:
§ 211. Independent consumer assistance program. The superintendent, in consultation with the commissioner of health, shall designate an independent consumer assistance program that will have the following duties:
(a) The independent consumer assistance program shall:
(1) assist consumers with the filing of complaints and appeals, including filing appeals with the internal appeal or grievance process of the group health plans or health insurance issuers involved and providing information about and assisting consumers with the external appeals and administrative hearing process;
(2) collect, track, and quantify problems and inquiries encountered by consumers;
(3) educate consumers on their rights and responsibilities with respect to group health plans and health insurance coverage;
(4) assist consumers with enrollment in a group health plan or health insurance coverage by providing information, referral, and assistance;
(5) resolve problems with obtaining premium tax credits under section 36B of the Internal Revenue Code of 1986;
(6) assist consumers with disputes eligible for resolution under article six of the financial services law;
(7) assist uninsured, insured, or underinsured consumers in accessing appropriate health care services, hospital financial assistance or the resolution of their health care bills; and
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11109-01-9
A. 7754 2
(8) provide assistance to health consumers on any additional matters related to accessing health insurance coverage and health care services.
(b) All New York state regulated health plans shall be required to list the name, phone number, address and email of the state independent consumer assistance programs on notices to consumers of adverse determinations and explanation of benefits and in the subscriber agreement, member handbook and any additional consumer facing materials as determined by the superintendent and the commissioner of health.
§ 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.