265.988 Payment Of Balance Of Bills By Secondary Health Insurance Agencies:
MSSNY will seek legislative reform in the New York State Insurance Law that would: (a) require all health insurance plans licensed in this state to include a Coordination of Benefits (COB) clause in their contracts clearly delineating their responsibilities as secondary insurers; (b) require that when a dually covered person complies with the provisions of a primary health insurance Plan by obtaining treatment from a participating physician, the secondary plan (by virtue of premiums paid for its coverage) must honor the liability for payment of deductible, coinsurance, co-payment and/or balance payment amounts (up to the highest payment level of the two insurance plans) regardless of the treating physician’s participation status with the secondary insurer; (c) require all health insurance plans licensed in this state to provide full and clear disclosure about a Plan’s secondary liability to its insured and its contracted physicians at the time of enrollment; and (d) require the New York State Department of Financial Services to review health insurers’ reports concerning savings they have accrued in their roles as secondary payers and to pass on these savings to consumers in the form of reduced premiums. (HOD 1997-279; Reaffirmed HOD 2000-264 & HOD 2006-259; Amended HOD 2016)
