What's happening
This bill allows claims for municipal cooperative health benefit plans to be adjusted by certain officers or employees without a separate license.
Why it matters
Expands who can adjust claims. The bill allows officers or employees of a municipal cooperative health benefit plan (not just licensed adjusters) to process and adjust claims, potentially streamlining administrative processes for these plans.
Could reduce administrative costs. By letting salaried officers and employees handle claims without needing a separate adjuster’s license, municipal cooperatives might save money on licensing and third-party services, possibly lowering overhead.
May improve service speed and flexibility. Allowing internal staff to manage claims could lead to faster resolutions and more responsive service for municipalities participating in these cooperative plans, benefiting public employees and local governments.
Aligns municipal plans with private insurers. This change extends a privilege already available to certain private insurance company employees, promoting parity between public and private sector health plan administration.
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Who cares
Headline styles
Let Municipal Health Plans Adjust Claims
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Referred to insurance
- Referred to insurance
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3508
2019-2020 Regular Sessions
IN SENATE
February 8, 2019
Introduced by Sens. BRESLIN, SEWARD -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to adjusting claims on behalf of municipal cooperative health benefit plans
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subparagraph (B) of paragraph 1 of subsection (g) of section 2101 of the insurance law, as amended by chapter 301 of the laws of 2008, is amended to read as follows:
(B) any officer, director or regular salaried employee of an insurer authorized to write accident and health insurance, a corporation licensed under article forty-three of this chapter (collectively, as used in this paragraph, a "health insurer") or a health maintenance organization, or any manager thereof, individual or corporate, when the claim to be adjusted is issued or administered by another health insurer or health maintenance organization within the same holding company system as the health insurer or health maintenance organization adjusting the claim or is adjusted on behalf of a municipal cooperative health benefit plan certified pursuant to article forty-seven of this chapter;
§ 2. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD09757-01-9
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 adjusting claims on behalf of municipal cooperative health benefit plans
Purpose
This bill excepts health insurers adjusting claims on behalf of a munic- ipal cooperative health benefit plan from the definition of "independent adjuster."
Summary of provisions
Section one amends subsection (B) of section (1) of paragraph (g) of section 2101 of the insurance law to provide that a health insurer is not acting as an independent adjuster when it adjusts claims on behalf of a municipal cooperative health benefit plan certified pursuant to article forty seven of the insurance law.
Section 2 sets the effective date.
Justification
Article 47 of the insurance law includes a number of provisions that together permit municipalities to form a cooperative health benefit plan. Of particular significance is the requirement that the municipal cooperative health benefit plan be "fully insured." Section 4702 of the Insurance Law provides that "fully insured means that all benefits paya- ble pursuant to a municipal cooperative health benefit plan are guaran- teed under a contract of policy of insurance delivered in this state and issued by an insurance company authorized to do accident and health insurance in this state, an article forty-three corporation, or a health maintenance organization."
The Department of Financial Services has taken the position that when a health insurer adjusts claims on behalf of a municipal cooperative health benefit plan certified pursuant to Article 47 of the Insurance Law, the health insurer is acting as an independent adjuster and must be licensed as such. To require a health insurer to be separately licensed as an independent adjuster in order to adjust claims under a fully insured contract issued by the health insurer is an unreasonable and unnecessary result. This bill would clarify that a health insurer issu- ing a fully insured contract to a municipal cooperative health benefit plan need not be licensed as an independent adjuster in order to adjust claims under its own contract.
Legislative history
S.4242 of 2017-18 S.7651 of 2016, passed both houses.
Fiscal implications
None.
Effective date
This act shall take effect immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.