BILL NUMBER: S8124
SPONSOR: ASHBY
 
TITLE OF BILL:
An act to amend the insurance law, in relation to circumstances under
which a consumer may be subject to a new special open enrollment period
to choose a new health insurance plan
 
PURPOSE:
To allow consumers the opportunity of a "qualifying life event" if their
provider went out of network due to a contractual dispute between the
provider and insurer.
 
SUMMARY OF PROVISIONS:
Section 1 amends section 3217 of the insurance law by adding
paragraph(6), which provides that if a contract is severed with one or
more of a consumer's existing health care providers upon no fault of
such consumer, then a new special open enrollment period shall commence
to allow such consumer an opportunity to choose a new health insurance
plan that may allow for continuity of care with an existing health care
provider; provided that such health insurance policy or contract shall
not impose a fee or other penalty for special enrollment of such consum-
er; and provided further that upon enrollment, coverage shall be effec-
tive no later than 14 days after such consumer purchases the new health
insurance policy.
Section 2 amends section 4306 of the insurance law by adding new section
(p) that states that all contracts made must state in writing that if a
contract is severed upon no fault of the consumer, that a special open
enrollment period shall be allowed pursuant to paragraph 6 of subsection
(b) of section 3217.
 
JUSTIFICATION:
Consumers can only change medical insurance during either end-of-year
enrollment periods or at the time of "qualifying life events" such as
pregnancy, divorce or a job change. On the flip side, insurers'
contracts with doctors, hospitals and pharmaceutical companies can
change abruptly due to contract disputes.
In 2024, the Capital Region experienced multiple months-long insurer and
provider disputes that left the healthcare of tens of thousands of
consumers in limbo. If an insurer-provider contract lapsed there were
some patients who would have been eligible for continuity of care such
as women who were pregnant or were post-partum or those persons diag-
nosed with cancer or actively receiving cancer treatment. However, that
same solace of maintaining your preferred provider is not extended in
those circumstances to thousands of other consumers undergoing other
types of care. Elected officials throughout the Capital Region fielded
numerous constituent concerns during those disputes. In one instance
while the provider and insurer battled in the newspapers, a person
seeing a heart specialist was forced to agonize for weeks over whether
to switch providers or to pay out-of-pocket should their insurer drop
their specialist from their network.Eò
This bill would allow consumers the opportunity of a "qualifying life
event" if their provider went out of network due to a contractual
dispute between the provider and insurer. Consumers would be able to go
back to the healthcare marketplace to select insurance that their
preferred provider offers for continuity of care. It is unfair to the
consumer that after they select a healthcare plan for the calendar year
that their providers could be dropped mid-year. This bill would offer
the consumer a remedy to situations outside of their control and allow
access to the healthcare of their choice.
 
LEGISLATIVE HISTORY:
New
 
FISCAL IMPLICATIONS:
To be determined.
 
EFFECTIVE DATE:
This act shall take effect immediately.