Bill Text: NY S04122 | 2025-2026 | General Assembly | Introduced

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Bill Title: 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.

Spectrum: Moderate Partisan Bill (Democrat 11-2)

Status: (Introduced) 2025-02-03 - REFERRED TO CIVIL SERVICE AND PENSIONS [S04122 Detail]

Download: New_York-2025-S04122-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          4122

                               2025-2026 Regular Sessions

                    IN SENATE

                                    February 3, 2025
                                       ___________

        Introduced by Sens. JACKSON, BROUK, CLEARE, COMRIE, FERNANDEZ, HARCKHAM,
          HOYLMAN-SIGAL,  MARTINEZ,  MATTERA,  PALUMBO,  SEPULVEDA, WEBB -- read
          twice and ordered printed, and when printed to  be  committed  to  the
          Committee on Civil Service and Pensions

        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  (i)  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, is amended to read as follows:
     4    (i) Any and all health insurance coverage mandated by any law, rule or
     5  regulation,  including  but not limited to coverage mandated pursuant to
     6  article forty-three of the insurance law, applicable  to  contracts  for
     7  health  insurance entered into under this section shall be provided in a
     8  manner assuring uninterrupted continuance of coverage  for  all  covered
     9  persons. Health benefits shall include a requirement that covered health
    10  care  services  provided  to plan participants will be reimbursed at the
    11  level of at least eighty percent of the usual and customary cost of each
    12  out-of-network health   care service.  As  used  in  this  subparagraph,
    13  "usual  and  customary  cost" shall mean the eightieth percentile of all
    14  charges for the particular health care service performed by  a  provider
    15  in  the  same or similar specialty and provided in the same geographical
    16  area as reported in a benchmarking database maintained  by  a  nonprofit
    17  organization  specified by the superintendent of financial services. For
    18  the purposes of this paragraph "coverage" shall include but shall not be
    19  limited to all benefits, services,  rights,  privileges  and  guarantees
    20  allowed by law;

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD06196-01-5
        S. 4122                             2

     1    §  2.  Subdivision  1  of  section  161-a of the civil service law, as
     2  amended by section 10 of part T of chapter 56 of the laws  of  2010,  is
     3  amended to read as follows:
     4    1.  Where,  and to the extent that, an agreement between the state and
     5  an employee organization entered into pursuant to  article  fourteen  of
     6  this  chapter provides for health benefits, the president, after receipt
     7  of written directions from the director  of  employee  relations,  shall
     8  implement  the  provisions  of  such agreement consistent with the terms
     9  thereof and to the extent necessary shall  adopt  regulations  providing
    10  for  the  benefits  to  be  thereunder provided. The president, with the
    11  approval of the director of the budget, may  extend  such  benefits,  in
    12  whole  or in part, provided that such benefits are not a diminishment of
    13  current existing benefits to employees not subject to the provisions  of
    14  such agreement.
    15    § 3. This act shall take effect immediately.