S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________

                                         5655

                              2005-2006 Regular Sessions

                                 I N  A S S E M B L Y

                                   February 25, 2005
                                      ___________

       Introduced  by  M.  of  A.  LAFAYETTE  --  read once and referred to the
         Committee on Insurance

       AN ACT to amend the  insurance  law,  in  relation  to  prohibiting  the
         payment of health insurance benefits which duplicate benefits recover-
         able under mandatory motor vehicle no-fault insurance policies

         THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
       BLY, DO ENACT AS FOLLOWS:

    1    Section 1. Statement of legislative findings and intent. The  escalat-
    2  ing  cost  of health care services, no-fault motor vehicle insurance and
    3  health insurance is a matter of vital concern. Duplication of  insurance
    4  coverage  for  health insurance results in over-utilization of available
    5  health care services, resulting in higher  cost  of  such  services  and
    6  higher cost of insurance covering such services.
    7    Under  the  state`s  compulsory  no-fault motor vehicle insurance law,
    8  most victims of motor vehicle accidents occurring in New York state  are
    9  entitled  to  be reimbursed by their motor vehicle insurance company for
   10  all of the necessary expenses for health care services resulting from  a
   11  motor  vehicle  accident  injury,  up  to a very high dollar limit. This
   12  responsibility of the motor vehicle insurance  carrier  is  mandated  by
   13  present law and exists even though health insurance coverage may also be
   14  available for payment of the same health care expenses.
   15    This  act  is  intended to have a favorable impact on health insurance
   16  costs by eliminating duplication of such coverage when the loss is  also
   17  covered by mandatory motor vehicle insurance.
   18    S  2.  Section  3216  of  the insurance law is amended by adding a new
   19  subsection (m) to read as follows:
   20    (M) NOTWITHSTANDING THE PROVISIONS OF SUBSECTION (G) OF THIS  SECTION,
   21  NO  POLICY  ISSUED,  RENEWED,  AMENDED  OR  MODIFIED IN THIS STATE WHICH
   22  PROVIDES COVERAGE FOR PROFESSIONAL HEALTH SERVICES, DEFINED IN PARAGRAPH
   23  ONE OF SUBSECTION (A) OF SECTION FIVE THOUSAND ONE HUNDRED TWO  OF  THIS
   24  CHAPTER, SHALL PROVIDE ANY BENEFITS WHICH DUPLICATE BENEFITS RECOVERABLE

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             { } is old law to be omitted.
                                                                  LBD09125-01-5

       A. 5655                             2

    1  UNDER MANDATORY MOTOR VEHICLE NO-FAULT INSURANCE POLICIES. THE EXCLUSION
    2  PROVISION  TO  BE  INCLUDED IN THE INDIVIDUAL POLICY AND THE APPROPRIATE
    3  ADJUSTMENT OF THE PREMIUM RATE SHALL BE SUBJECT TO THE APPROVAL  OF  THE
    4  SUPERINTENDENT.
    5    S  3.  Section  3221  of  the insurance law is amended by adding a new
    6  subsection (r) to read as follows:
    7    (R) NO GROUP OR BLANKET INSURANCE POLICY ISSUED, RENEWED,  AMENDED  OR
    8  MODIFIED  IN  THIS STATE WHICH PROVIDES COVERAGE FOR PROFESSIONAL HEALTH
    9  SERVICES, DEFINED IN PARAGRAPH ONE OF SUBSECTION  (A)  OF  SECTION  FIVE
   10  THOUSAND  ONE  HUNDRED  TWO  OF THIS CHAPTER, SHALL PROVIDE ANY BENEFITS
   11  WHICH DUPLICATE  BENEFITS  RECOVERABLE  UNDER  MANDATORY  MOTOR  VEHICLE
   12  NO-FAULT  INSURANCE  POLICIES. THE EXCLUSION PROVISION TO BE INCLUDED IN
   13  THE GROUP OR BLANKET POLICY AND THE APPROPRIATE ADJUSTMENT OF THE PREMI-
   14  UM RATE SHALL BE SUBJECT TO THE APPROVAL OF THE SUPERINTENDENT.
   15    S 4. Section 4303 of the insurance law is  amended  by  adding  a  new
   16  subsection (ee) to read as follows:
   17    (EE)  NO  DIRECT  PAYMENT CONTRACT, GROUP REMITTANCE CONTRACT OR GROUP
   18  CONTRACT ISSUED, RENEWED,  AMENDED  OR  MODIFIED  IN  THIS  STATE  WHICH
   19  PROVIDES COVERAGE FOR PROFESSIONAL HEALTH SERVICES, DEFINED IN PARAGRAPH
   20  ONE  OF  SUBSECTION (A) OF SECTION FIVE THOUSAND ONE HUNDRED TWO OF THIS
   21  CHAPTER, SHALL PROVIDE ANY BENEFITS WHICH DUPLICATE BENEFITS RECOVERABLE
   22  UNDER MANDATORY MOTOR VEHICLE NO-FAULT INSURANCE POLICIES. THE EXCLUSION
   23  PROVISION TO BE INCLUDED IN THE CONTRACT AND THE APPROPRIATE  ADJUSTMENT
   24  OF  THE PREMIUM RATE SHALL BE SUBJECT TO THE APPROVAL OF THE SUPERINTEN-
   25  DENT.
   26    S 5. This act shall take effect on the one hundred eightieth day after
   27  it shall have become a law.