S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         2066
                              2015-2016 Regular Sessions
                                 I N  A S S E M B L Y
                                   January 15, 2015
                                      ___________
       Introduced  by  M.  of  A.  ZEBROWSKI  --  read once and referred 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:
    1    Section 1. The insurance law is amended by adding a new section 3217-h
    2  to read as follows:
    3    S 3217-H. DISCLOSURE  OF  INFORMATION  TO  MUNICIPALITIES.  (A)  EVERY
    4  INSURER  CONTRACTING  WITH MUNICIPALITIES EMPLOYING FOUR HUNDRED OR MORE
    5  EMPLOYEES, INCLUDING MUNICIPAL COOPERATIVE HEALTH BENEFIT  PLANS  CERTI-
    6  FIED PURSUANT TO ARTICLE FORTY-SEVEN OF THIS CHAPTER, SHALL PROVIDE UPON
    7  REQUEST THE FOLLOWING INFORMATION TO THE INSURED MUNICIPALITY:
    8    (1) SPECIFIC CLAIMS EXPERIENCE COVERED BY THE INSURER UNDER A COMMUNI-
    9  TY  RATED  OR  EXPERIENCED  RATED POLICY.   FOR PURPOSES OF THIS SECTION
   10  "EXPERIENCE RATINGS" SHALL MEAN AND INCLUDE  ALL  QUANTITATIVE  MEASURES
   11  USED  BY  THE  INSURANCE  CARRIER  SUCH  AS  EXPENSES PER MEMBER AND ANY
   12  HISTORICAL DATA;
   13    (2) AVERAGE ANNUAL PER MEMBER COST OF CLAIMS REIMBURSEMENT;
   14    (3) NUMBER OF MEMBERS WHO DID NOT FILE A CLAIM WITHIN A  TWELVE  MONTH
   15  PERIOD;
   16    (4)  A COMPARISON OF EMERGENCY SERVICES USED BY MEMBERS TO OUT-PATIENT
   17  SERVICES;
   18    (5) A LOSS RATIO REPORT;
   19    (6) CLAIMS HISTORY FOR THE LAST TWELVE  MONTHS  FOR  EXPERIENCE  RATED
   20  PLANS SEPARATED BY MEDICAL AND PRESCRIPTION;
   21    (7)  INFORMATION  REGARDING  COST  ON THE TOP TWENTY-FIVE PRESCRIPTION
   22  DRUGS BEING USED BY MEMBER EMPLOYEES;
   23    (8) LARGE LOSS CLAIMS REPORT INDICATING DIAGNOSIS  AND  PROGNOSIS  FOR
   24  CLAIMS GREATER THAN THIRTY THOUSAND DOLLARS;
   25    (9) MEDICAL LOSS RATIO REPORT; AND
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD02936-01-5
       A. 2066                             2
    1    (10)  ANY  OTHER  STATISTICAL INFORMATION THE MUNICIPALITY REQUESTS TO
    2  DETERMINE USE OF BENEFITS BY MEMBERS.
    3    (B)  THE  SUPERINTENDENT SHALL IMPOSE A FINE OF THREE HUNDRED THOUSAND
    4  DOLLARS FOR FAILURE TO PROVIDE WITHIN THIRTY DAYS OF A  WRITTEN  REQUEST
    5  BY THE INSURED MUNICIPALITY THE INFORMATION REQUIRED BY PARAGRAPH ONE OF
    6  SUBSECTION  (A) OF THIS SECTION RELATING TO HOW FUNDING WAS SPENT BY THE
    7  INSURANCE CARRIER REGARDING THE INSURED EMPLOYEES. A FINE OF  TEN  THOU-
    8  SAND  DOLLARS PER DAY SHALL BE IMPOSED FOR EACH DAY SUCH FAILURE CONTIN-
    9  UES.   ANY FINES IMPOSED SHALL  BE  PAID  TO  THE  INSURED  MUNICIPALITY
   10  REQUESTING SUCH INFORMATION.
   11    (C)  NOTWITHSTANDING  THE  FOREGOING PROVISIONS, IN RELEASING ANY SUCH
   12  INFORMATION THE INSURER SHALL COMPLY WITH THE FEDERAL  HEALTH  INSURANCE
   13  PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) OF 1996, AS AMENDED.
   14    S 2. This act shall take effect immediately.