Bill Text: NY S00166 | 2011-2012 | General Assembly | Introduced

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Bill Title: Provides that health insurers may not deny reimbursements to insureds because the registered pharmacy providing pharmaceutical products has not been approved by the insurer or other entity.

Spectrum: Moderate Partisan Bill (Republican 4-1)

Status: (Introduced - Dead) 2012-01-18 - PRINT NUMBER 166A [S00166 Detail]

Download: New_York-2011-S00166-Introduced.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                          166
                              2011-2012 Regular Sessions
                                   I N  S E N A T E
                                      (PREFILED)
                                    January 5, 2011
                                      ___________
       Introduced  by  Sens.  MAZIARZ, GOLDEN, LITTLE -- read twice and ordered
         printed, and when printed to be committed to the Committee  on  Insur-
         ance
       AN  ACT  to  amend  the  insurance  law, in relation to health insurance
         coverage and to eligibility for employee benefits provided by employee
         welfare funds
         THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
    2  amended by adding a new paragraph 28 to read as follows:
    3    (28) NO SUCH POLICY SHALL LIMIT BENEFITS  OR  DENY  REIMBURSEMENT  FOR
    4  BENEFITS  TO  ANY  INSURED ON THE BASIS THAT THE PHARMACY PROVIDING SUCH
    5  BENEFITS HAS NOT BEEN SPECIFICALLY SELECTED OR APPROVED. IF THE INSURED,
    6  HIS DEPENDENTS OR BOTH RECEIVE SERVICES FROM A  PHARMACY  OF  THEIR  OWN
    7  CHOOSING,  SUCH  INSURED  SHALL  PAY  THE  COST  OF  SUCH PHARMACEUTICAL
    8  PRODUCTS TO THE EXTENT THAT SUCH  COST  EXCEEDS  THE  BENEFITS  PROVIDED
    9  UNDER  THE POLICY WITHOUT FORFEITURE OF THE BENEFITS PROVIDED UNDER SUCH
   10  POLICY. NO SUCH POLICY SHALL PROHIBIT A DULY  REGISTERED  PHARMACY  FROM
   11  PROVIDING  SERVICES,  PROVIDED  SUCH  PHARMACY  AGREES  TO  PROVIDE SUCH
   12  SERVICES IN ACCORDANCE WITH THE MINIMUM  STANDARDS  AND  CONDITIONS  FOR
   13  SIMILAR PROVIDERS THAT HAVE BEEN ESTABLISHED BY SUCH POLICY.
   14    S 2. Subsection (e) of section 3221 of the insurance law is amended by
   15  adding a new paragraph 12 to read as follows:
   16    (12)  NO  SUCH  GROUP  OR  BLANKET POLICY SHALL LIMIT BENEFITS OR DENY
   17  REIMBURSEMENT FOR BENEFITS TO ANY INSURED ON THE BASIS THAT THE PHARMACY
   18  PROVIDING SUCH BENEFITS HAS NOT BEEN SPECIFICALLY SELECTED  OR  APPROVED
   19  BY  THE  GROUP OR BLANKET POLICY. IF THE INSURED, HIS DEPENDENTS OR BOTH
   20  RECEIVE SERVICES FROM A PHARMACY OF THEIR  OWN  CHOOSING,  SUCH  INSURED
   21  SHALL  PAY  THE  COST OF SUCH PHARMACEUTICAL PRODUCTS TO THE EXTENT THAT
   22  SUCH COST EXCEEDS THE BENEFITS PROVIDED UNDER THE GROUP OR BLANKET POLI-
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD01652-01-1
       S. 166                              2
    1  CY WITHOUT FORFEITURE OF THE BENEFITS PROVIDED UNDER SUCH GROUP OR BLAN-
    2  KET POLICY. NO SUCH GROUP OR BLANKET POLICY SHALL PROHIBIT A DULY REGIS-
    3  TERED PHARMACY FROM PROVIDING SERVICES, PROVIDED SUCH PHARMACY AGREES TO
    4  PROVIDE  SUCH  SERVICES  IN  ACCORDANCE  WITH  THE MINIMUM STANDARDS AND
    5  CONDITIONS FOR SIMILAR PROVIDERS THAT  HAVE  BEEN  ESTABLISHED  BY  SUCH
    6  GROUP OR BLANKET POLICY.
    7    S  3.  Section  4303  of  the insurance law is amended by adding a new
    8  subsection (hh) to read as follows:
    9    (HH) NO SUCH POLICY ISSUED BY A  THIRD  PARTY  BENEFIT  PROGRAM  SHALL
   10  LIMIT  BENEFITS OR DENY REIMBURSEMENT FOR SERVICES TO ANY INSURED ON THE
   11  BASIS THAT THE PHARMACY PROVIDING SUCH BENEFITS  HAS  NOT  BEEN  SPECIF-
   12  ICALLY  SELECTED  OR APPROVED BY THE THIRD PARTY BENEFIT PROGRAM. IF THE
   13  INSURED, HIS DEPENDENTS OR BOTH RECEIVE  SERVICES  FROM  A  PHARMACY  OF
   14  THEIR OWN CHOOSING, SUCH INSURED SHALL PAY THE COST OF SUCH TREATMENT TO
   15  THE EXTENT THAT SUCH COST EXCEEDS THE BENEFITS PROVIDED UNDER THE POLICY
   16  WITHOUT  FORFEITURE  OF THE BENEFITS PROVIDED UNDER SUCH POLICY. NO SUCH
   17  THIRD PARTY BENEFIT PROGRAM SHALL PROHIBIT A  DULY  REGISTERED  PHARMACY
   18  FROM  PROVIDING  SERVICES,  PROVIDED  SUCH  PHARMACY  AGREES  TO PROVIDE
   19  SERVICES IN ACCORDANCE WITH THE MINIMUM  STANDARDS  AND  CONDITIONS  FOR
   20  SIMILAR PROVIDERS THAT HAVE BEEN ESTABLISHED BY SUCH THIRD PARTY BENEFIT
   21  PROGRAM.
   22    S 4. Subsection (b) of section 4402 of the insurance law is amended to
   23  read as follows:
   24    (b)  "Employee  benefits"  means  one or more benefits or services for
   25  employees or their families or dependents, or for both,  including,  but
   26  not  limited to, medical, surgical or hospital care or benefits PROVIDED
   27  BY OR PERFORMED BY ANY PHARMACY, benefits  in  the  event  of  sickness,
   28  accident, disability or death, benefits in the event of unemployment, or
   29  retirement benefits.
   30    S 5. Subsection (b) of section 4413 of the insurance law is amended by
   31  adding a new paragraph 1-a to read as follows:
   32    (1-A) NO SUCH FUND SHALL LIMIT EMPLOYEE BENEFITS OR DENY REIMBURSEMENT
   33  FOR  EMPLOYEE  BENEFITS  TO  ANY ELIGIBLE EMPLOYEE ON THE BASIS THAT THE
   34  PHARMACY PROVIDING SUCH BENEFITS HAS NOT BEEN SPECIFICALLY  SELECTED  OR
   35  APPROVED  BY  THE  WELFARE  FUND, THE EMPLOYER OR THE LABOR ORGANIZATION
   36  REPRESENTING THE EMPLOYEES ELIGIBLE FOR SUCH EMPLOYEE BENEFITS.  IF  THE
   37  ELIGIBLE  EMPLOYEE, HIS DEPENDENTS OR BOTH RECEIVE SERVICES FROM A PHAR-
   38  MACY OF THEIR OWN CHOOSING, SUCH EMPLOYEE SHALL PAY  THE  COST  OF  SUCH
   39  TREATMENT  TO  THE  EXTENT  THAT SUCH COST EXCEEDS THE BENEFITS PROVIDED
   40  UNDER THE PLAN WITHOUT FORFEITURE OF THE BENEFITS  PROVIDED  UNDER  SUCH
   41  PLAN.    NO  SUCH  FUND, EMPLOYER OR LABOR ORGANIZATION SHALL PROHIBIT A
   42  DULY REGISTERED PHARMACY   FROM PROVIDING  EMPLOYEE  BENEFITS,  PROVIDED
   43  SUCH  PHARMACY  AGREES  TO  PROVIDE SUCH SERVICES IN ACCORDANCE WITH THE
   44  MINIMUM STANDARDS AND CONDITIONS FOR SIMILAR PROVIDERS  THAT  HAVE  BEEN
   45  ESTABLISHED BY SUCH FUND, EMPLOYER OR LABOR ORGANIZATION.
   46    S 6. Subsection (b) of section 4301 of the insurance law is amended by
   47  adding a new paragraph 4 to read as follows:
   48    (4)  IF  A  CONTRACT  ISSUED BY A THIRD PARTY BENEFIT PROGRAM PROVIDES
   49  BENEFITS FOR PHARMACY SERVICES, PRESCRIPTION DRUGS OR FOR  PARTICIPATION
   50  IN  A  PRESCRIPTION DRUG PLAN, ANY PHARMACY WILLING TO PARTICIPATE UNDER
   51  THE TERMS OF THE CONTRACT SHALL NOT BE DENIED  ACCESS  TO  THE  PROVIDER
   52  PANEL.
   53    S  7. This act shall take effect on the first of January next succeed-
   54  ing the date on which it shall have become a law and shall apply to  all
   55  policies  and contracts issued, renewed, modified, altered or amended on
   56  or after such effective date.