BILL NUMBER: S8957
SPONSOR: HOYLMAN-SIGAL
 
TITLE OF BILL:
An act to amend the insurance law and the public health law, in relation
to providing insurance coverage for rare diseases, life-threatening
conditions or diseases, degenerative and disabling conditions, or diag-
noses involving medically fragile children
 
PURPOSE:
To require insurance coverage in certain instances for rare diseases,
life-threatening conditions or diseases, degenerative and disabling
conditions or diagnoses involving medically fragile children.
 
SUMMARY OF PROVISIONS:
Sections one through three amend various sections of the insurance law
to require insurance coverage for above referenced conditions by out of
network providers if (i) costs are equal or less than in network, and
there is no cost for traveling,(ii) advanced notice is provided to the
patient's network plan, and (iii) the chosen provider is specialized in
the area of treatment.
Section four provides for conforming changes to the public health law to
include health maintenance organizations in the requirements for treat-
ing the conditions covered by the insurance law.
Section five provides for an effective date of ninety days from enact-
ment.
 
JUSTIFICATION:
Individuals who are diagnosed with rare diseases, life threatening or
life altering diseases, or are deemed medically fragile children are
already undergoing enormous amounts of stress without having to consider
who they are going to seek medical care from. Their focus should instead
be on who is going to provide them with the best chance of survival or
success from their diagnosis. This should also be the policy of the
State. No one should be told that there is a better, more qualified
specialist available at the same cost, but they cannot see them because
they are arbitrarily either in or out of network.
This legislation is intended to offer individuals confronted with rare
or life altering circumstances the ability to choose the best treatment
option for them. These changes also take into account mandates on the
insurance plans by controlling costs, providing notice, and ensuring the
chosen provider is a qualified specialist. Individuals who find them-
selves in these daunting circumstances should have the ability to
explore options, even if those are out of network in order to provide
them with the greatest chance of a positive outcome.
 
LEGISLATIVE HISTORY:
This is a new bill.
 
FISCAL IMPLICATIONS:
None.
 
EFFECTIVE DATE:
Ninety days after it shall have become law.

Statutes affected:
S8957: 3221 insurance law, 3221(k) insurance law, 4303 insurance law