NY State Senate Bill 2015-S5029A

Senate Bill S5029A

2015-2016 Legislative Session

Prohibits health insurers from removing covered services and benefits upon contract renewal

download bill text pdf

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 23, 2016	print number 5029a
May 23, 2016	amend (t) and recommit to insurance
Jan 06, 2016	referred to insurance
Apr 29, 2015	referred to insurance

Bill Amendments

Original

A (Active)

2015-S5029 - Details

See Assembly Version of this Bill:: A10211
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2017-2018 Legislative Session:: S5777

2015-S5029 - Summary

Provides that no covered services or benefits under a policy of accident and health insurance shall be altered or modified under a contract for renewal.

2015-S5029 - Sponsor Memo

                                BILL NUMBER:S5029

TITLE OF BILL:

An act to amend the insurance law, in relation to qualified health
plans

PURPOSE:

This bill amends the insurance law in relation to notification
requirements for Qualified Health Plans under specific circumstances.

SUMMARY OF PROVISIONS:

Section 1 amends the insurance law to establish certain notification
requirements for Qualified Health Plans (QHPs) when enrollees enter
the second and third months of the 90 day grace period for nonpayment
of premiums for health insurance purchased through the health
insurance exchange.

Section 2 - Effective date.

JUSTIFICATION:

This legislation adds a new section 3242 to the Insurance Law that
would establish notification requirements for a health plan when an

enrollee has entered the second and third months of the grace period.
Subsection (b) of such section would require QHPs to notify a
provider, upon request, that an enrollee is in the grace period within
three business days after the submittal of a claim or upon request by
a provider.

Under the Affordable Care Act, a QHP must provide a grace period of
three consecutive months before terminating coverage if an enrollee
receiving advanced payments of the premium tax credit has previously
paid at least one full month's premium during the benefit year.
During the grace period, the QHP must pay all appropriate claims for
services rendered to the enrollee during the first month of the grace
period and may pend claims for services rendered to the enrollee in
the second and third months of the grace period. QHPs must also notify
providers of the possibility for denied claims for enrollees within
the second and third months of the grace period; however, there is no
guidance on how notifications must be provided or the time period in
which such notifications must be given.

Without sufficient notification, patients may risk receiving
potentially uncovered services, perhaps unknowingly. Timely
notification enables providers, if necessary, to provide additional
information to patients about financial assistance and will also help
such providers anticipate or mitigate the effect of potential claim
denials.

LEGISLATIVE HISTORY:

Same as S.7501 of 2014.

FISCAL IMPLICATIONS:


None.

EFFECTIVE DATE:

This act shall take effect July 1, 2016.

2015-S5029 - Bill Text download pdf

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

                                  5029

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                             April 29, 2015
                               ___________

Introduced  by  Sen.  HANNON -- 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 qualified health plans

  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 3242
to read as follows:
  S 3242. QUALIFIED HEALTH PLANS: PREMIUMS AND  GRACE  PERIOD.  (A)  FOR
PURPOSES OF THIS SECTION:
  (1)  "QUALIFIED HEALTH PLAN" SHALL HAVE THE SAME MEANING AS DEFINED IN
SECTION 1301 OF THE AFFORDABLE CARE ACT, 42 U.S.C. S 18021, OR ANY REGU-
LATIONS PROMULGATED THEREUNDER.
  (2) "GRACE PERIOD" MEANS THE THREE MONTH PERIOD ALLOWED FOR NONPAYMENT
OF PREMIUMS BY AN ENROLLEE PURSUANT TO SECTION 1412  OF  THE  AFFORDABLE
CARE ACT, 42 U.S.C. S 18082, OR ANY REGULATIONS PROMULGATED THEREUNDER.
  (B)  FOR  AN ENROLLEE WHO IS IN THE SECOND OR THIRD MONTH OF THE GRACE
PERIOD, AN ISSUER OF A QUALIFIED HEALTH PLAN SHALL:
  (1) UPON REQUEST BY A PROVIDER, PROVIDE INFORMATION WITHIN THREE BUSI-
NESS DAYS REGARDING THE ENROLLEE'S ELIGIBILITY STATUS, TRANSMITTED ELEC-
TRONICAL TO THE EXTENT PRACTICABLE; AND
  (2) NOTIFY A PROVIDER THAT AN ENROLLEE IS IN THE GRACE  PERIOD  WITHIN
THREE BUSINESS DAYS AFTER THE SUBMITTAL OF A CLAIM OR STATUS REQUEST FOR
SERVICES  PROVIDED,  WITH  SUCH NOTIFICATION, TO THE EXTENT PRACTICABLE,
PROVIDED ELECTRONICALLY.
  S 2. This act shall take effect July 1, 2016.



 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10705-01-5

2015-S5029A (ACTIVE) - Details

See Assembly Version of this Bill:: A10211
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2017-2018 Legislative Session:: S5777

2015-S5029A (ACTIVE) - Summary

Provides that no covered services or benefits under a policy of accident and health insurance shall be altered or modified under a contract for renewal.

2015-S5029A (ACTIVE) - Sponsor Memo

2015-S5029A (ACTIVE) - Bill Text download pdf

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

                                 5029--A

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                             April 29, 2015
                               ___________

Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance  --  recommitted
  to the Committee on Insurance in accordance with Senate Rule 6, sec. 8
  --  committee  discharged,  bill amended, ordered reprinted as amended
  and recommitted to said committee

AN ACT to amend the insurance law, in  relation  to  prohibiting  health
  insurers  from  removing  covered  services and benefits upon contract
  renewal

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

  Section  1.  Section  3216 of the insurance law is amended by adding a
new subsection (c-1) to read as follows:
  (C-1) NO COVERED SERVICES OR BENEFITS UNDER A POLICY OF  ACCIDENT  AND
HEALTH  INSURANCE  SHALL  BE  ALTERED  OR  MODIFIED UNDER A CONTRACT FOR
RENEWAL.
  S 2. Section 3221 of the insurance law is  amended  by  adding  a  new
subsection (c-1) to read as follows:
  (C-1)  NO  COVERED SERVICES OR BENEFITS UNDER A POLICY OF ACCIDENT AND
HEALTH INSURANCE SHALL BE ALTERED  OR  MODIFIED  UNDER  A  CONTRACT  FOR
RENEWAL.
  S  3.  Section  4303  of  the insurance law is amended by adding a new
subsection (c-1) to read as follows:
  (C-1) NO COVERED SERVICES OR BENEFITS UNDER A POLICY OF  ACCIDENT  AND
HEALTH  INSURANCE  SHALL  BE  ALTERED  OR  MODIFIED UNDER A CONTRACT FOR
RENEWAL.
  S 4. This act shall take effect on the sixtieth  day  after  it  shall
have  become a law and shall apply to all policies and contracts issued,
renewed, modified, altered or amended on or after such date.


 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10705-02-6

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