What's happening
The bill requires insurers to provide explanations of pharmaceutical benefits to policyholders when claims are filed under certain health insurance policies.
Why it matters
Expanding transparency. By requiring insurers to provide explanations of pharmaceutical benefits, the bill ensures that patients better understand how their prescription drug claims are processed and what is covered, helping them make more informed decisions about their healthcare.
Addressing out-of-pocket surprises. Clear explanations of pharmaceutical benefits can help policyholders anticipate costs for medications, reducing the likelihood of unexpected expenses and potential financial hardship when filling prescriptions.
Improving oversight and accountability. With insurers now required to disclose details about pharmaceutical benefits, it becomes easier to identify potential errors or inappropriate denials, empowering consumers to challenge decisions or pursue appeals when necessary.
Aligning pharmaceutical coverage with other benefits. The bill places pharmaceutical claims on the same footing as hospital and medical claims regarding transparency, closing a loophole and ensuring consistent consumer protections across different types of health insurance benefits.
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Who cares
Headline styles
Require Drug Benefit Explanations
Plain English, a few words. Used as the page title.
Sponsors
Assembly Member · Assembly District 108
No co-sponsors yet.
History
- Enacting clause stricken
- Referred to insurance
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
7946
2019-2020 Regular Sessions
IN ASSEMBLY
May 29, 2019
Introduced by M. of A. McDONALD -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to requiring insurers to provide insureds or subscribers with an explanation of pharmaceutical benefits relating to claims under certain accident and health insurance policies
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 3234 of the insurance law, as added by chapter 731 of the laws of 1993, is renumbered section 3244 and subsection (a) of such section is amended to read as follows:
(a) Every insurer, including health maintenance organizations operating under article forty-four of the public health law or article fortythree of this chapter and any other corporation operating under article forty-three of this chapter, is required to provide the insured or subscriber with an explanation of benefits form in response to the filing of any claim under a policy or certificate providing coverage for hospital [or], medical or pharmaceutical expenses, including policies and certificates providing nursing home expense or home care expense benefits.
§ 2. This act shall take effect on the sixtieth day after it shall become a law and shall apply to all claims filed on and after such effective date. Effective immediately the addition, amendment and/or repeal of any rule or regulation necessary for the implementation of this act on its effective date are authorized to be made and completed on or before such date.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10851-02-9
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.