What's happening
This bill requires health insurers to provide copies of group contracts to covered individuals upon written request within thirty days.
Why it matters
Empowers employees covered by collectively bargained group health insurance plans. to directly access the full contract language, increasing transparency about their rights, benefits, and obligations.
Facilitates more informed healthcare decisions. by ensuring individuals can review the actual terms of their group insurance, rather than relying solely on summaries or third-party explanations.
Improves accountability for insurers. by imposing a 30-day deadline to provide requested documents, reducing bureaucratic delays and potential barriers to information.
Supports dispute resolution and benefits advocacy. by giving covered individuals the documentation needed to challenge denials, resolve ambiguities, or seek assistance with coverage issues.
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Who cares
Headline styles
Insurers Must Respond in 30 Days
Plain English, a few words. Used as the page title.
Sponsors
Senator · Senate District 14
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.
Faster Health Plan Documents
In Assembly Committee · Insurance · Sponsor Vivian Cook
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
5502
2019-2020 Regular Sessions
IN SENATE
May 3, 2019
Introduced by Sen. COMRIE -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law and the public health law, in relation to disclosure and access to health insurance plan documents
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph 3 of subsection (b) of section 3217-a of the insurance law, as added by chapter 705 of the laws of 1996, is amended to read as follows:
(3) provide a copy of the most recent individual, direct pay subscriber contracts and, upon the written request of an individual covered under a group contract which was the subject of collective bargaining, provide a copy of such contract within thirty days of the receipt of such request;
§ 2. Paragraph 3 of subsection (b) of section 4324 of the insurance law, as added by chapter 705 of the laws of 1996, is amended to read as follows:
(3) provide a copy of the most recent individual, direct pay subscriber contracts and, upon the written request of an individual covered under a group contract which was the subject of collective bargaining, provide a copy of such contract within thirty days of the receipt of such request;
§ 3. Paragraph (c) of subdivision 2 of section 4408 of the public health law, as added by chapter 705 of the laws of 1996, is amended to read as follows:
(c) provide a copy of the most recent individual, direct pay subscriber contracts and, upon the written request of an individual covered under a group contract which was the subject of collective bargaining, provide a copy of such contract within thirty days of the receipt of such request;
§ 4. This act shall take effect on the sixtieth day after it shall have become a law.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD07985-02-9
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 and the public health law, in relation to disclosure and access to health insurance plan documents
Purpose
This bill requires that within thirty days of a request by an insured or prospective insured, a health insurer shall supply a copy of the most recent group insurance policy or contract to a subscriber.
Summary of provisions
Section 1: Amends Insurance Law section 3217-a to require that all insurers that offer comprehensive, expense-reimbursed health insurance contracts, managed care contracts, or other health insurance contracts shall provide, upon request, to an insured or subscriber, within 30 days, a copy of the most recent group policy or contract to such insured or subscriber.
Section 2: Amends Insurance Law section 4324 to require all Article 43 corporations that offer comprehensive, expense-reimbursed contracts, or managed care products, shall provide, upon request, to an insured or subscriber, within 30 days, a copy of the most recent group policy or contract to such insured or subscriber.
Section 3: Amends Public Health Law section 4408 to require all Health Maintenance Organizations that offer managed health care products, shall provide, upon request, to a health care subscriber, within 30 days, a copy of the most recent group contract to such subscriber.
Existing law
Under current law, individual direct pay subscribers are able to obtain, upon request, a copy of their health insurance policy or contract. This provision is, however, not extended to those policyholders or subscrib- ers that have group or other managed care health insurance products.
Justification
The process by which health insurance contracts are negotiated has become more complex. Generally, health insurance policies or contracts for educational employees are purchased based on negotiations between the health insurer and individual school districts or a cooperative group of employees employed in several school districts. Because these contracts are embodied in collective bargaining agreements reached between each employer and its employees, there are several different health insurance contracts held by individual school districts within a consortium.
At a time when health care benefits and their costs are constantly changing, it is important for all parties to be informed of their bene- fit coverages and costs. All insureds should be fully aware of their coverage levels and costs for such coverage levels. Under current law, while a policyholder, subscriber or employer school district may have access to a summary of the insurance contract, there is no clear way for such persons or school district to obtain an actual copy of the policy, contract or certificate. This can be particularly harmful to an insured because in the event of inconsistency between the insurance coverage summary and the actually executed policy or contract, the terms of the executed contract control the level of coverage and its costs. Under current law, health insurers may modify the level or type of coverage without each individual insured's knowledge of such changes.
In some cases, the employee insured may only find out about the change in coverage when the statement of payment is received. Also, the current system obstructs the ability to adjudicate a claim dispute and makes it difficult for employers and employee representatives to make informed decisions regarding plan design and content and to compare competitive proposals without the contract.
Legislative history
Previously Introduced; 2017/18 A.2054
Fiscal implications
None.
Local fiscal implications
None.
Effective date
This act shall take effect on the sixtieth day after it shall have become a law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.