STATE OF NEW YORK ________________________________________________________________________ 8035 2023-2024 Regular Sessions IN ASSEMBLY September 13, 2023 ___________ Introduced by M. of A. STECK -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law and the public health law, in relation to electronic notification when prior authorization is required to fill a prescription The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraphs 13 and 14 of subsection (b) of section 3217-a of 2 the insurance law, as added by section 2 of part H of chapter 60 of the 3 laws of 2014, are amended and a new paragraph 15 is added to read as 4 follows: 5 (13) disclose whether a health care provider scheduled to provide a 6 health care service is an in-network provider; [and] 7 (14) with respect to out-of-network coverage, disclose the approximate 8 dollar amount that the insurer will pay for a specific out-of-network 9 health care service. The insurer shall also inform the insured through 10 such disclosure that such approximation is not binding on the insurer 11 and that the approximate dollar amount that the insurer will pay for a 12 specific out-of-network health care service may change[.]; and 13 (15) where applicable, allow an insured to request an electronic 14 notification within thirty days when prior authorization is required to 15 fill a prescription. 16 § 2. Paragraphs 13 and 14 of subsection (b) of section 4324 of the 17 insurance law, as added by section 9 of part H of chapter 60 of the laws 18 of 2014, are amended and a new paragraph 15 is added to read as follows: 19 (13) disclose whether a health care provider scheduled to provide a 20 health care service is an in-network provider; [and] 21 (14) with respect to out-of-network coverage, disclose the approximate 22 dollar amount that the corporation will pay for a specific out-of-net- 23 work health care service. The corporation shall also inform the insured 24 through such disclosure that such approximation is not binding on the EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD13192-01-3
A. 8035 2 1 corporation and that the approximate dollar amount that the corporation 2 will pay for a specific out-of-network health care service may 3 change[.]; and 4 (15) where applicable, allow an insured to request an electronic 5 notification within thirty days when prior authorization is required to 6 fill a prescription. 7 § 3. Paragraphs (m) and (n) of subdivision 2 of section 4408 of the 8 public health law, as added by section 19 of part H of chapter 60 of the 9 laws of 2014, are amended and a new paragraph (o) is added to read as 10 follows: 11 (m) disclose whether a health care provider scheduled to provide a 12 health care service is an in-network provider; [and] 13 (n) with respect to out-of-network coverage, disclose the approximate 14 dollar amount that the health maintenance organization will pay for a 15 specific out-of-network health care service. The health maintenance 16 organization shall also inform an enrollee through such disclosure that 17 such approximation is not binding on the health maintenance organization 18 and that the approximate dollar amount that the health maintenance 19 organization will pay for a specific out-of-network health care service 20 may change[.]; and 21 (o) where applicable, allow an insured to request an electronic 22 notification within thirty days when prior authorization is required to 23 fill a prescription. 24 § 4. This act shall take effect immediately.