What's happening
This bill requires New York to establish an independent consumer assistance program to help residents navigate health insurance issues and disputes.
Why it matters
Expands support for health insurance consumers. The bill mandates a program offering in-depth, hands-on help to New Yorkers facing health insurance disputes or confusion, covering everything from appeals to understanding rights and responsibilities.
Targets vulnerable populations. By assisting uninsured, underinsured, or insured individuals with access to care, financial assistance, and bill resolution, the program aims to reduce medical debt and barriers to health care for those most at risk.
Requires health plans to inform consumers. All state-regulated health plans must clearly provide contact information for the assistance program in key documents, making it easier for people to find help when they encounter coverage problems or denied claims.
Creates data for oversight and improvement. The program will track and analyze consumer problems and inquiries, generating information that can highlight systemic issues and inform future policy or regulatory changes.
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Who cares
Headline styles
Help For Insurance Consumers
Plain English, a few words. Used as the page title.
Sponsors
3 Co-sponsors
History
- Committed to rules
- Advanced to third reading
- 2nd report cal.
- 1st report cal.523
- Referred to insurance
- Returned to senate
- Died in assembly
- Referred to insurance
- Delivered to assembly
- Passed senateVote 61–1
- Advanced to third reading
- 2nd report cal.
Show 2 earlier actions
- 1st report cal.989
- 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.
Create Consumer Assistance Program
In Assembly Committee · Insurance · Sponsor Richard Gottfried
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
5145
2019-2020 Regular Sessions
IN SENATE
April 11, 2019
Introduced by Sen. RIVERA -- 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 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
S. 5145 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.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to the designation of an independent consumer assistance program
Purpose
To designate an independent consumer assistance program, their duties, and require that New York state regulated health plans provide contact information of the state independent consumer assistance programs to consumers.
Summary of provisions
Section one of the bill amends the insurance law by adding a new section that the superintendent of financial services, in consultation with the commissioner of health, shall designate an independent consumer assist- ance program. The legislation designates the duties of independent consumer assistance program, and requires that New York State regulated health plans provide contact information of the state independent consumer assistance program to consumers on various documents.
Section two of the bill establishes the effective date.
Justification
Navigating the healthcare system can prove difficult. Complications include being uninsured, underinsured, or being denied coverage for services.
New York State's healthcare consumer assistance program has assisted New Yorkers with navigating their health insurance coverage, resolving bill- ing issues, coverage denials, getting prior authorization and accessing affordable healthcare. Community health advocates also assist small business owners to understand how they can offer health insurance and get health insurance tax credits. The program was initially established and funded as part of the Affordable Care Act. The program has been incredibly successful, and has handled over 337,000 cases since 2010, including over 28,000 cases in 2018 alone. It has also been saving New Yorkers' money. It is estimated that the program has saved $35 million since 2010, and $5.9 million in 2018.
This bill would include the existing, funded program in New York Statute to ensure that community health advocate services continue to operate in the state. This bill also establishes the duties that are required to be designated as an independent consumer assistance program, and requires that all New York State regulated health plans provide contact informa- tion of the state independent consumer assistance programs on notices to consumers of adverse determinations, as well as other documentation. This will ensure that consumers are aware of the consumer assistance programs, are able to reach out for assistance and New Yorkers have the supports they need to continue to access coverage and services.
Legislative history
New bill.
Fiscal implications
None.
Local fiscal implications
None.
Effective date
The 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.