What's happening
This bill requires health insurers to disclose the type of health plan a policyholder is enrolled in when claim liability is unclear.
Why it matters
Improves transparency for consumers and providers. By requiring insurers to specify the exact type of health plan (e.g., Medicaid, Child Health Plus, Basic Health Program, Exchange plan, or other regulated products), patients and healthcare providers can better understand what coverage rules and benefits apply when there’s a dispute or uncertainty over a claim.
Reduces administrative confusion and delays. Clear identification of plan types can help resolve billing disputes faster, minimize miscommunication between insurers, providers, and patients, and potentially speed up the claims process when liability isn’t immediately clear.
Helps ensure appropriate protections and rights. Different plan types come with distinct consumer protections, cost-sharing limits, and appeal rights; knowing the precise coverage helps patients and providers assert the correct legal rights or obligations tied to that plan.
Limits discrimination risk. The bill explicitly prohibits discrimination based on the source of payment, ensuring that disclosing the type of coverage cannot be used to deny or alter services improperly.
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Who cares
Headline styles
Disclose Insurance Coverage Details
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Returned to senate
- Died in assembly
- Referred to insurance
- Delivered to assembly
- Passed senateVote 62–0
- Ordered to third reading cal.1373
- Referred to rules
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
6341
2019-2020 Regular Sessions
IN SENATE
June 5, 2019
Introduced by Sen. BRESLIN -- read twice and ordered printed, and when printed to be committed to the Committee on Rules
AN ACT to amend the insurance law, in relation to requiring health insurers to provide, when liability for a claim is not reasonably clear, the coverage the policyholder or covered person is enrolled in
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph 2 of subsection (b) of section 3224-a of the insurance law, as amended by chapter 237 of the laws of 2009, is amended and a new paragraph 3 is added to read as follows:
(2) to request all additional information needed to determine liability to pay the claim or make the health care payment[.]; and
(3) of the specific type of plan or product the policyholder or covered person is enrolled in; provided that nothing in this section shall authorize discrimination based on the source of payment.
§ 2. Subsection (d) of section 3224-a of the insurance law is amended by adding a new paragraph 3 to read as follows:
(3) "plan or product" shall mean:
(i) medicaid coverage certified pursuant to section three hundred sixty-four-j of the social services law;
(ii) a child health insurance plan certified pursuant to section twenty-five hundred eleven of the public health law;
(iii) basic health program coverage certified pursuant to section three hundred sixty-nine-gg of the social services law, including the specific rating group the policyholder or covered person is enrolled in;
(iv) coverage purchased on the New York insurance exchange established pursuant to article sixty-two of this chapter; and
(v) any other product fully insured and regulated by the state under article forty-two, forty-three, or forty-seven of this chapter, or article forty-four of the public health law.
§ 3. This act shall take effect July 1, 2020.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD13221-01-9
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 requiring health insurers to provide, when liability for a claim is not reasonably clear, the coverage the policyholder or covered person is enrolled in
Purpose
The require plans to clearly identify to a provider the product an indi- vidual is enrolled in for health coverage purposes.
Summary of provisions
Section 1 amends subsection (b) of paragraph (2) of section 3224-a of the Insurance Law to add a new requirement that an insurer identify the specific type of plan or product the policy-holder or covered person is enrolled in.
Section 2 amends subsection (d) of section 3224-a of the Insurance law to add a new paragraph 3 to define the plans or products that must be identified by the insurer.
Section 3 provides that this act shall take effect July 1, 2018.
Justification
Hospitals and health care providers are currently challenged with iden- tifying which specific health plan a patient is enrolled in. Health- plans today offer a wide variety of products, which can make it very difficult to identify what particular health coverage a patient has. There is no requirement for plans to consistently and uniformly identify what particular product an individual is enrolled in.
The current inability to identify these products or the regulatory rules that apply causes providers, regulators, and plans to waste valuable resources appealing, communicating, and replacing claims incorrectly or when it is not necessary. Under the current system, identification of the type of coverage is ultimately made after an appeal is submitted by a patient or a provider and after these resources have already been wasted.
This bill would ensure plans provide the necessary information at the time the plan makes a payment determination. This will avoid wasting time and energy on filing unnecessary appeals and identify protections available for patients based on their particular coverage by ensuring clear and consistent information about the particular product a patient is enrolled in.
Legislative history
2016: 5.7370 2018: S.5779a
Fiscal implications
None
Effective date
July 1, 2020
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.