Requires insurance companies to disclose claims information to municipalities employing 400 or more employees to determine how their benefits are used; provides for imposition of a fine for failure to disclose such information in a timely manner.

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S2056-2013 Actions

• Jan 10, 2013: REFERRED TO INSURANCE

S2056-2013 Memo

BILL NUMBER:S2056

TITLE OF BILL:  An act to amend the insurance law, in relation to
requiring insurance companies to disclose claims information to
municipalities

PURPOSE OR GENERAL IDEA OF BILL: This bill allows the different levels
of government employing 400 or more workers an opportunity to assess
accurately the true needs of their employees when addressing health
care benefits. It will create transparency allowing these governments
to negotiate more effectively with all insurance companies that are
bidding on future contracts.

SUMMARY OF SPECIFIC PROVISIONS: Section 1. Amends the insurance law by
adding a new section 3217-g to read as follows:

� 3217-g Disclosure of information, to municipalities. (a) Every
insurer contracting with municipalities, including cooperative health
benefit plans certified pursuant to article forty-seven of this
chapter shall provide upon request the following information to the
insured municipality.

1. Specific claims information must be furnished by the insurer under
community rated or experience rated policies;

2. Average annual per member cost of claims reimbursement;

3. Number of members that did not file a claim within a 12 month
period;

4. A comparison of emergency services used by members to out-patient
services; and

5. Provide municipality with loss ratio report

6. Claims history for the last 12 months must be provided for
experience rated plans separated by medical and prescription.

7. Information regarding cost on to 25 prescription drug being used by
member employees.

8. Large loss claims report indicating diagnosis and prognosis for
claims greater than $30,000.00.

9. Medical loss ratio report.

10. Any other statistical information the municipality requests to
determine use of benefits by members.

B. The superintendent shall impose a fine of three hundred thousand
dollars for failure to provide within thirty days of a written request
by the insured municipality the information required by paragraph one
of subsection (a) of this section regarding the insured employees. A
fine of ten thousand dollars a day will be imposed for every day such
failure continues; any fines imposed shall be paid directly to the
municipality requesting such information.


C. All information being released shall be done so in compliance with
the federal health insurance portability and accountability act
(HIPAA) of 1996.

Definition

The experience ratings will include all quantitative measures used by
the insurance company such as expenses per member, data supporting
said expenses and any historical data that will help determine the
risk of future claims. This information will provide transparency for
purposes of negotiations in future contracts.

EXISTING LAW: Article 32, subdivision 1 of section 3217 of Insurance
Law is amended to include a subsection 3217-G as listed above

JUSTIFICATION: Every year villages, towns, cities and counties in New
York State are forced to put in place a budget that best meets the
needs of those governments. It is necessary for those creating budgets
to have access to accurate numbers that reflect a true need.  Without
under standing how well health care programs are being utilized, it is
very difficult to negotiate in good faith with insurance carriers.
Large insurance carriers will continue to have an unfair advantage
over governments until transparencies exist and negotiations reflect
actual cost.

PRIOR LEGISLATIVE HISTORY:  2009-10- A.9130-B (Latimer) Referred to
Insurance 2011-12- A.101 (Latimer) Referred to Insurance 2009-10-
S.7560 (Parker) Referred to Insurance 2011-12- S.1120 (Parker)
Referred to Insurance

FISCAL IMPLICATIONS: None to New York State

LOCAL FISCAL IMPLICATIONS:  To be determined

EFFECTIVE DATE: This act will take effect immediately.

S2056-2013 Text

                      S T A T E   O F   N E W   Y O R K
  ________________________________________________________________________

                                    2056

                         2013-2014 Regular Sessions

                              I N  SENATE

                              January 10, 2013
                                 ___________

  Introduced  by  Sen. LATIMER -- 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  insurance
    companies to disclose claims information to municipalities

    THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
  BLY, DO ENACT AS FOLLOWS:


    Section 1. The insurance law is amended by adding a new section 3217-g
  to read as follows:

    S 3217-G. DISCLOSURE  OF  INFORMATION  TO  MUNICIPALITIES.  (A)  EVERY
  INSURER  CONTRACTING  WITH MUNICIPALITIES EMPLOYING FOUR HUNDRED OR MORE
  EMPLOYEES, INCLUDING MUNICIPAL COOPERATIVE HEALTH BENEFIT  PLANS  CERTI-
  FIED PURSUANT TO ARTICLE FORTY-SEVEN OF THIS CHAPTER, SHALL PROVIDE UPON
  REQUEST THE FOLLOWING INFORMATION TO THE INSURED MUNICIPALITY:

    (1) SPECIFIC CLAIMS EXPERIENCE COVERED BY THE INSURER UNDER A COMMUNI-
  TY  RATED  OR  EXPERIENCED  RATED POLICY.   FOR PURPOSES OF THIS SECTION
  "EXPERIENCE RATINGS" SHALL MEAN AND INCLUDE  ALL  QUANTITATIVE  MEASURES
  USED  BY  THE  INSURANCE  CARRIER  SUCH  AS  EXPENSES PER MEMBER AND ANY
  HISTORICAL DATA;
    (2) AVERAGE ANNUAL PER MEMBER COST OF CLAIMS REIMBURSEMENT;
    (3) NUMBER OF MEMBERS WHO DID NOT FILE A CLAIM WITHIN A  TWELVE  MONTH
  PERIOD;
    (4)  A COMPARISON OF EMERGENCY SERVICES USED BY MEMBERS TO OUT-PATIENT
  SERVICES;
    (5) A LOSS RATIO REPORT;
    (6) CLAIMS HISTORY FOR THE LAST TWELVE  MONTHS  FOR  EXPERIENCE  RATED
  PLANS SEPARATED BY MEDICAL AND PRESCRIPTION;
    (7)  INFORMATION  REGARDING  COST  ON THE TOP TWENTY-FIVE PRESCRIPTION
  DRUGS BEING USED BY MEMBER EMPLOYEES;
    (8) LARGE LOSS CLAIMS REPORT INDICATING DIAGNOSIS  AND  PROGNOSIS  FOR
  CLAIMS GREATER THAN THIRTY THOUSAND DOLLARS;
    (9) MEDICAL LOSS RATIO REPORT; AND

   EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                        [ ] is old law to be omitted.
                                                             LBD05135-01-3

 S. 2056                             2

    (10)  ANY  OTHER  STATISTICAL INFORMATION THE MUNICIPALITY REQUESTS TO
  DETERMINE USE OF BENEFITS BY MEMBERS.
    (B)  THE  SUPERINTENDENT SHALL IMPOSE A FINE OF THREE HUNDRED THOUSAND
  DOLLARS FOR FAILURE TO PROVIDE WITHIN THIRTY DAYS OF A  WRITTEN  REQUEST
  BY THE INSURED MUNICIPALITY THE INFORMATION REQUIRED BY PARAGRAPH ONE OF
  SUBSECTION  (A) OF THIS SECTION RELATING TO HOW FUNDING WAS SPENT BY THE
  INSURANCE CARRIER REGARDING THE INSURED EMPLOYEES. A FINE OF  TEN  THOU-
  SAND  DOLLARS PER DAY SHALL BE IMPOSED FOR EACH DAY SUCH FAILURE CONTIN-
  UES.   ANY FINES IMPOSED SHALL  BE  PAID  TO  THE  INSURED  MUNICIPALITY
  REQUESTING SUCH INFORMATION.
    (C)  NOTWITHSTANDING  THE  FOREGOING PROVISIONS, IN RELEASING ANY SUCH
  INFORMATION THE INSURER SHALL COMPLY WITH THE FEDERAL  HEALTH  INSURANCE
  PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) OF 1996, AS AMENDED.
    S 2. This act shall take effect immediately.