NY Ins L § 4306-C (2021)
2021 New York Laws ISC - Insurance Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations 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.