A 5106: Prohibits an insurer or health maintenance organization from including certain requirements in insurance contracts.

  
  STATE OF NEW YORK ________________________________________________________________________ 5106 2025-2026 Regular Sessions  IN ASSEMBLY February 12, 2025 ___________ Introduced by M. of A. HUNTER -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law and the public health law, in relation to prohibiting certain requirements in insurance contracts The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 3217-b of the insurance law is amended by adding a 2 new subsection (p) to read as follows: 3 (p)(1) No insurer that offers a managed care product or a comprehen- 4 sive policy that utilizes a network of providers shall enter into a 5 contract, written policy, written procedure or agreement with any health 6 care provider that: 7 (A) Requires an insurer to include all members of a provider group, 8 including medical practice groups and facilities, in its network of 9 participating providers; 10 (B) Requires an insurer to place all members of a provider group, 11 including medical practice groups and facilities, in the same network 12 tier; 13 (C) Requires an insurer to include all members of a provider group, 14 including medical practice groups and facilities, in all products 15 offered by the insurer; 16 (D) Prohibits insurers from using benefit designs to encourage members 17 to seek services from higher-value health care providers; 18 (E) Contains a most-favored-nation provision; provided, however, noth- 19 ing in this section shall be construed to prohibit a health insurer and 20 a provider from negotiating payment rates and performance-based contract 21 terms that would result in the insurer receiving a rate that is as 22 favorable, or more favorable, than the rates negotiated between a health 23 care provider and another entity; and EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD08595-01-5 
 A. 5106 2 1 (F) Limits the ability of the insurer or health care provider from 2 disclosing fees for services or the allowed amounts to an insured or 3 insured's health care provider. 4 (2) After January first, two thousand twenty-six, any contract, writ- 5 ten policy, written procedure or agreement that contains a clause 6 contrary to the provisions set forth in this section shall be null and 7 void; provided, however, the remaining clauses of the contract shall 8 remain in effect for the duration of the contract term. 9 § 2. Section 4406 of the public health law is amended by adding a new 10 subdivision 6 to read as follows: 11 6. (a) No health maintenance organization that offers a managed care 12 product or a comprehensive policy that utilizes a network of providers 13 shall enter into a contract, written policy, written procedure or agree- 14 ment with any health care provider that: 15 (i) Requires an insurer to include all members of a provider group, 16 including medical practice groups and facilities, in its network of 17 participating providers; 18 (ii) Requires an insurer to place all members of a provider group, 19 including medical practice groups and facilities, in the same network 20 tier; 21 (iii) Requires an insurer to include all members of a provider group, 22 including medical practice groups and facilities, in all products 23 offered by the insurer; 24 (iv) Prohibits insurers from using benefit designs to encourage 25 members to seek services from higher-value health care providers; 26 (v) Contains a most-favored-nation provision; provided, however, noth- 27 ing in this section shall be construed to prohibit a health insurer and 28 a provider from negotiating payment rates and performance-based contract 29 terms that would result in the insurer receiving a rate that is as 30 favorable, or more favorable, than the rates negotiated between a health 31 care provider and another entity; and 32 (vi) Limits the ability of the insurer or health care provider from 33 disclosing fees for services or the allowed amounts to an insured or 34 insured's health care provider. 35 (b) After January first, two thousand twenty-six, any contract, writ- 36 ten policy, written procedure or agreement that contains a clause 37 contrary to the provisions set forth in this section shall be null and 38 void; provided, however, the remaining clauses of the contract shall 39 remain in effect for the duration of the contract term. 40 § 3. This act shall take effect January 1, 2026.