Bill Text: NY S01106 | 2013-2014 | General Assembly | Introduced

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Bill Title: Provides that health insurance coverage may not deny reimbursements because the registered laboratory providing laboratory services has not been approved by the insurer or other entity; provides that in such case the insured pays excess costs therefor above the covered benefit.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2014-01-08 - REFERRED TO INSURANCE [S01106 Detail]

Download: New_York-2013-S01106-Introduced.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         1106
                              2013-2014 Regular Sessions
                                   I N  S E N A T E
                                      (PREFILED)
                                    January 9, 2013
                                      ___________
       Introduced  by  Sen. MAZIARZ -- 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  health  insurance
         coverage  and  eligibility  for employee benefits provided by employee
         welfare funds for laboratory services
         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 30 to read as follows:
    3    (30) NO SUCH POLICY SHALL LIMIT BENEFITS  OR  DENY  REIMBURSEMENT  FOR
    4  BENEFITS  TO ANY INSURED ON THE BASIS THAT THE LABORATORY PROVIDING SUCH
    5  BENEFITS HAS NOT BEEN SPECIFICALLY SELECTED OR APPROVED. IF THE INSURED,
    6  HIS OR HER DEPENDENTS OR BOTH RECEIVE  SERVICES  FROM  A  LABORATORY  OF
    7  THEIR  OWN  CHOOSING, SUCH INSURED SHALL PAY THE COST OF SUCH LABORATORY
    8  SERVICES 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 LABORATORY  FROM
   11  PROVIDING  SERVICES,  PROVIDED  SUCH  LABORATORY  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 13 to read as follows:
   16    (13)  NO  SUCH  GROUP  OR  BLANKET POLICY SHALL LIMIT BENEFITS OR DENY
   17  REIMBURSEMENT FOR BENEFITS TO ANY INSURED ON THE BASIS THAT THE  LABORA-
   18  TORY  PROVIDING  SUCH  BENEFITS  HAS  NOT  BEEN SPECIFICALLY SELECTED OR
   19  APPROVED BY THE GROUP OR BLANKET POLICY. IF  THE  INSURED,  HIS  OR  HER
   20  DEPENDENTS  OR  BOTH  RECEIVE  SERVICES  FROM  A LABORATORY OF THEIR OWN
   21  CHOOSING, SUCH INSURED SHALL PAY THE COST OF SUCH LABORATORY SERVICES TO
   22  THE EXTENT THAT SUCH COST EXCEEDS THE BENEFITS PROVIDED UNDER THE  GROUP
   23  OR BLANKET POLICY WITHOUT FORFEITURE OF THE BENEFITS PROVIDED UNDER SUCH
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD02288-01-3
       S. 1106                             2
    1  GROUP  OR BLANKET POLICY. NO SUCH GROUP OR BLANKET POLICY SHALL PROHIBIT
    2  A DULY REGISTERED LABORATORY  FROM  PROVIDING  SERVICES,  PROVIDED  SUCH
    3  LABORATORY  AGREES TO PROVIDE SUCH SERVICES IN ACCORDANCE WITH THE MINI-
    4  MUM STANDARDS AND CONDITIONS FOR SIMILAR PROVIDERS THAT HAVE BEEN ESTAB-
    5  LISHED BY SUCH GROUP OR BLANKET POLICY.
    6    S  3.  Section  4303  of  the insurance law is amended by adding a new
    7  subsection (jj) to read as follows:
    8    (JJ) NO SUCH POLICY ISSUED BY A  THIRD  PARTY  BENEFIT  PROGRAM  SHALL
    9  LIMIT  BENEFITS OR DENY REIMBURSEMENT FOR SERVICES TO ANY INSURED ON THE
   10  BASIS THAT THE LABORATORY PROVIDING SUCH BENEFITS HAS NOT  BEEN  SPECIF-
   11  ICALLY  SELECTED  OR APPROVED BY THE THIRD PARTY BENEFIT PROGRAM. IF THE
   12  INSURED, HIS OR HER DEPENDENTS OR BOTH RECEIVE SERVICES FROM A LABORATO-
   13  RY OF THEIR OWN CHOOSING, SUCH INSURED SHALL PAY THE COST OF SUCH TREAT-
   14  MENT TO THE EXTENT THAT SUCH COST EXCEEDS THE  BENEFITS  PROVIDED  UNDER
   15  THE  POLICY WITHOUT FORFEITURE OF THE BENEFITS PROVIDED UNDER SUCH POLI-
   16  CY. NO SUCH THIRD PARTY BENEFIT PROGRAM SHALL PROHIBIT A DULY REGISTERED
   17  LABORATORY FROM PROVIDING SERVICES, PROVIDED SUCH LABORATORY  AGREES  TO
   18  PROVIDE SERVICES IN ACCORDANCE WITH THE MINIMUM STANDARDS AND CONDITIONS
   19  FOR  SIMILAR  PROVIDERS  THAT  HAVE BEEN ESTABLISHED BY SUCH THIRD PARTY
   20  BENEFIT PROGRAM.
   21    S 4. Subsection (b) of section 4402 of the insurance law is amended to
   22  read as follows:
   23    (b) "Employee benefits" means one or more  benefits  or  services  for
   24  employees  or  their families or dependents, or for both, including, but
   25  not limited to, medical, surgical or hospital care or benefits  PROVIDED
   26  BY  OR  PERFORMED  BY ANY LABORATORY, benefits in the event of sickness,
   27  accident, disability or death, benefits in the event of unemployment, or
   28  retirement benefits.
   29    S 5. Subsection (b) of section 4413 of the insurance law is amended by
   30  adding a new paragraph 1-a to read as follows:
   31    (1-A) NO SUCH FUND SHALL LIMIT EMPLOYEE BENEFITS OR DENY REIMBURSEMENT
   32  FOR EMPLOYEE BENEFITS TO ANY ELIGIBLE EMPLOYEE ON  THE  BASIS  THAT  THE
   33  LABORATORY PROVIDING SUCH BENEFITS HAS NOT BEEN SPECIFICALLY SELECTED OR
   34  APPROVED  BY  THE  WELFARE  FUND, THE EMPLOYER OR THE LABOR ORGANIZATION
   35  REPRESENTING THE EMPLOYEES ELIGIBLE FOR SUCH EMPLOYEE BENEFITS.  IF  THE
   36  ELIGIBLE EMPLOYEE, HIS OR HER DEPENDENTS OR BOTH RECEIVE SERVICES FROM A
   37  LABORATORY  OF  THEIR  OWN CHOOSING, SUCH EMPLOYEE SHALL PAY THE COST OF
   38  SUCH TREATMENT TO  THE  EXTENT  THAT  SUCH  COST  EXCEEDS  THE  BENEFITS
   39  PROVIDED  UNDER  THE  PLAN  WITHOUT  FORFEITURE OF THE BENEFITS PROVIDED
   40  UNDER SUCH PLAN.  NO SUCH FUND, EMPLOYER  OR  LABOR  ORGANIZATION  SHALL
   41  PROHIBIT  A DULY REGISTERED LABORATORY FROM PROVIDING EMPLOYEE BENEFITS,
   42  PROVIDED SUCH LABORATORY AGREES TO PROVIDE SUCH SERVICES  IN  ACCORDANCE
   43  WITH  THE  MINIMUM  STANDARDS  AND CONDITIONS FOR SIMILAR PROVIDERS THAT
   44  HAVE BEEN ESTABLISHED BY SUCH FUND, EMPLOYER OR LABOR ORGANIZATION.
   45    S 6. Subsection (b) of section 4301 of the insurance law is amended by
   46  adding a new paragraph 4 to read as follows:
   47    (4) IF A CONTRACT ISSUED BY A THIRD  PARTY  BENEFIT  PROGRAM  PROVIDES
   48  BENEFITS  FOR LABORATORY SERVICES, ANY LABORATORY WILLING TO PARTICIPATE
   49  UNDER THE TERMS OF THE CONTRACT  SHALL  NOT  BE  DENIED  ACCESS  TO  THE
   50  PROVIDER PANEL.
   51    S  7. This act shall take effect on the first of January next succeed-
   52  ing the date on which it shall have become a law and shall apply to  all
   53  policies  and contracts issued, renewed, modified, altered or amended on
   54  or after such effective date.