Bill Text: NY S04012 | 2025-2026 | General Assembly | Introduced

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Bill Title: Requires notification to insureds that an out-of-network physician may be used in their procedure, test or surgery and such physician's services shall not be covered by their insurance policy; provides such services must be covered if the insured person does not receive notification prior to such services or procedure.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2025-01-31 - REFERRED TO INSURANCE [S04012 Detail]

Download: New_York-2025-S04012-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          4012

                               2025-2026 Regular Sessions

                    IN SENATE

                                    January 31, 2025
                                       ___________

        Introduced  by  Sen.  PARKER -- 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 requiring notification
          to insured persons that an out-of-network physician  may  be  used  in
          their procedure, test or surgery

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Section 3216 of the insurance law is amended  by  adding  a
     2  new subsection (n) to read as follows:
     3    (n)  (1)  Every  person  insured under a policy of accident and health
     4  insurance delivered or issued for delivery in this state shall be  enti-
     5  tled  to  notification  from  the billing entity prior to the procedure,
     6  test or surgery, that an out-of-network physician may be  used  in  such
     7  procedure,  test  or  surgery and such physician's services shall not be
     8  covered by their insurance policy.
     9    (2) The patient costs of out-of-network physician  services  shall  be
    10  covered  by  the  insurance policy of an insured person if they have not
    11  received notification of such situations, prior to the health service or
    12  procedure, as prescribed in paragraph one of this subsection.
    13    § 2. Section 3221 of the insurance law is  amended  by  adding  a  new
    14  subsection (v) to read as follows:
    15    (v)  (1)  Every  person  insured under a policy of accident and health
    16  insurance delivered or issued for delivery in this state shall be  enti-
    17  tled  to  notification  from  the billing entity prior to the procedure,
    18  test or surgery, that an out-of-network physician may be  used  in  such
    19  procedure,  test  or  surgery and such physician's services shall not be
    20  covered by their insurance policy.
    21    (2) The patient costs of out-of-network physician  services  shall  be
    22  covered  by  the  insurance policy of an insured person if they have not
    23  received notification of such situations, prior to the health service or
    24  procedure, as prescribed in paragraph one of this subsection.
    25    § 3. This act shall take effect immediately.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD07470-01-5