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A07055 Summary:

BILL NOA07055
 
SAME ASSAME AS S05639-A
 
SPONSORMcDonald
 
COSPNSRFall, Alvarez, Lupardo, Thiele, Reyes, Stern, Lavine, Ramos, Solages, Aubry, Darling, Jean-Pierre, DeStefano, Smith, Giglio JA, Blumencranz, Durso, Simone, Mikulin, McDonough, Simon, Byrnes
 
MLTSPNSR
 
Amd 162 & 161-a, Civ Serv L
 
Clarifies that the New York state health insurance program remains subject to certain provisions of the financial services law and coverage for usual and customary costs for out-of-network health care service.
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A07055 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          7055
 
                               2023-2024 Regular Sessions
 
                   IN ASSEMBLY
 
                                      May 10, 2023
                                       ___________
 
        Introduced  by  M. of A. McDONALD, FALL -- read once and referred to the
          Committee on Governmental Employees
 
        AN ACT to amend the civil service law, in relation  to  clarifying  that
          the New York state health insurance program remains subject to certain
          provisions of the financial services law

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Subparagraph (iv) of paragraph  (b)  of  subdivision  1  of
     2  section 162 of the  civil service law, as amended by section 3 of part T
     3  of  chapter 56 of the laws of 2010 and as further amended by section 104
     4  of part A of chapter 62 of the laws of  2011,  is  amended  to  read  as
     5  follows:
     6    (iv)  Notwithstanding  the  provisions of this subdivision, the presi-
     7  dent's election to provide health benefits directly to plan participants
     8  shall not constitute the doing of insurance business within the  meaning
     9  of  article eleven of the insurance law; provided however, the provision
    10  of direct benefits as per this subdivision shall be subject to review by
    11  the superintendent of financial services for the  purposes  of  ensuring
    12  compliance  with  applicable  insurance  law  and any and all associated
    13  insurance rules and regulations as noted in this subdivision.   Further,
    14  the provision of direct benefits as per this subdivision, and any entity
    15  providing  administrative  services  regarding  those benefits, shall be
    16  subject to the jurisdiction of the department of financial  services  in
    17  accordance  with article three of the financial services law, as well as
    18  the provisions of article six of the financial services law.
    19    § 2. Subparagraph (i) of paragraph (b) of subdivision 1 of section 162
    20  of the civil service law, as amended by section 3 of part T  of  chapter
    21  56 of the laws of 2010, is amended to read as follows:
    22    (i) Any and all health insurance coverage mandated by any law, rule or
    23  regulation,  including  but not limited to coverage mandated pursuant to
    24  article forty-three of the insurance law, applicable  to  contracts  for
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09746-03-3

        A. 7055                             2
 
     1  health  insurance entered into under this section shall be provided in a
     2  manner assuring uninterrupted continuance of coverage  for  all  covered
     3  persons. Health benefits shall include a requirement that covered health
     4  care  services  provided  to plan participants will be reimbursed at the
     5  level of at least eighty percent of the usual and customary cost of each
     6  out-of-network health   care service.  As  used  in  this  subparagraph,
     7  "usual  and  customary  cost" shall mean the eightieth percentile of all
     8  charges for the particular health care service performed by  a  provider
     9  in  the  same or similar specialty and provided in the same geographical
    10  area as reported in a benchmarking database maintained  by  a  nonprofit
    11  organization  specified by the superintendent of financial services. For
    12  the purposes of this paragraph "coverage" shall include but shall not be
    13  limited to all benefits, services,  rights,  privileges  and  guarantees
    14  allowed by law;
    15    §  3.  Subdivision  1  of  section  161-a of the civil service law, as
    16  amended by section 10 of part T of chapter 56 of the laws  of  2010,  is
    17  amended to read as follows:
    18    1.  Where,  and to the extent that, an agreement between the state and
    19  an employee organization entered into pursuant to  article  fourteen  of
    20  this  chapter provides for health benefits, the president, after receipt
    21  of written directions from the director  of  employee  relations,  shall
    22  implement  the  provisions  of  such agreement consistent with the terms
    23  thereof and to the extent necessary shall  adopt  regulations  providing
    24  for  the  benefits  to  be  thereunder provided. The president, with the
    25  approval of the director of the budget, may  extend  such  benefits,  in
    26  whole  or in part, provided that such benefits are not a diminishment of
    27  current existing benefits to employees not subject to the provisions  of
    28  such agreement.
    29    § 4. This act shall take effect immediately.
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