New York Insurance Law Section 4306-C - Grievance procedure and access to specialty care.

  4306-c.  Grievance  procedure  and  access to specialty care. (a) A
  corporation, including a  municipal  cooperative  health  benefits  plan
  certified pursuant to article forty-seven of this chapter, that issues a
  comprehensive contract that utilizes a network of providers and is not a
  managed  care  health insurance contract as defined in subsection (c) of
  section four thousand eight hundred one of this chapter shall  establish
  and  maintain  a grievance procedure consistent with the requirements of
  section four thousand eight hundred two of this chapter.
(b) A corporation, including a municipal cooperative  health  benefits
  plan  certified  pursuant  to  article forty-seven of this chapter, that
  issues a comprehensive contract that utilizes a network of providers and
  is not a managed care health insurance contract as defined in subsection
  (c) of section four thousand eight  hundred  one  of  this  chapter  and
  requires  that  specialty care be provided pursuant to a referral from a
  primary care provider  shall  provide  access  to  such  specialty  care
  consistent  with  the  requirements  of  subsections (b), (c) and (d) of
  section four thousand eight  hundred  four  of  this  chapter;  provided
  however, that nothing in this section shall be construed to require that
  a  corporation, or a primary care provider on behalf of the corporation,
  make a referral to a provider that is not in the corporation's network.
(c) A corporation, including a municipal cooperative  health  benefits
  plan  certified  pursuant  to  article forty-seven of this chapter, that
  issues a comprehensive contract that utilizes a network of providers and
  is not a managed care health insurance contract as defined in subsection
  (c) of section four thousand eight hundred one  of  this  chapter  shall
  provide  access to transitional care consistent with the requirements of
  subsections (e) and (f) of section four thousand eight hundred  four  of
  this chapter.
(d)  A  corporation,  including a municipal cooperative health benefit
  plan certified pursuant to article forty-seven of  this  chapter  and  a
  student  health  plan  established or maintained pursuant to section one
  thousand  one  hundred  twenty-four  of  this  chapter,  that  issues  a
  comprehensive  policy  that utilizes a network of providers and is not a
  managed care health insurance contract as defined in subsection  (c)  of
  section  four  thousand eight hundred one of this chapter, shall provide
  access to out-of-network services consistent with  the  requirements  of
  subsection  (a)  of  section  four  thousand  eight hundred four of this
  chapter, subsections (g-6) and  (g-7)  of  section  four  thousand  nine
  hundred  of  this  chapter,  subsections (a-1) and (a-2) of section four
  thousand nine hundred four of this chapter, paragraphs three and four of
  subsection (b) of  section  four  thousand  nine  hundred  ten  of  this
  chapter,  and  subparagraphs (C) and (D) of paragraph four of subsection
  (b) of section four thousand nine hundred fourteen of this chapter.

Last modified: February 3, 2019