NY Pub Health L § 4406-A (2021)
2021 New York Laws PBH - Public Health Article 44 - Health Maintenance Organizations 4406-A - Arbitration Provisions of Health Maintenance Organization Contracts.

§  4406-a.  Arbitration  provisions of health maintenance organization   contracts. 1. The enrollee contract of a health maintenance organization   may permit enrollees and adult members of the enrollee's family who  are   covered by such contract to elect to have all claims for damages because   of  injury  or death resulting from health care or treatment rendered or   failed to be rendered pursuant to the contract by a physician,  dentist,   hospital,  health maintenance organization or other health care provider   subject to binding arbitration, pursuant to  article  seventy-five-A  of   the  civil  practice  law  and  rules. For the purposes of this section,   "health  maintenance   organizations"   shall   include   those   health   maintenance organizations organized pursuant to this article or pursuant   to  article  forty-three of the insurance law. The enrollee contract may   permit arbitration elections to be executed on behalf of minor  children   or  persons  judicially  determined to be incompetent by a parent, legal   guardian, committee or conservator or other person legally authorized to   enroll  the  minor  or  incompetent  person  in  a  health   maintenance   organization.  Arbitration  election  notices, described in subdivisions   two and three of this section, must be executed by covered adult  family   members in order to bind such persons to the arbitration election.2.  After  receiving  the  approval of the superintendent of financial   services, pursuant to section five thousand  six  hundred  five  of  the   insurance  law, health maintenance organizations may provide arbitration   election notices to current enrollees and  their  covered  adult  family   members.  Such  notice shall contain the following provision in at least   twelve point boldface type immediately above spaces for the signature of   the enrollee or covered adult family member: "By signing this form, I am   agreeing to have any issue of alleged health care malpractice decided by   neutral arbitration rather than by a court trial before a judge or jury.   (Health care malpractice means claims for damages because of  injury  or   death  resulting  from health care or treatment rendered or failed to be   rendered pursuant to my health maintenance organization contract by  the   health maintenance organization, a physician, dentist, hospital or other   health care provider.) I understand that I will be given the opportunity   to  cancel  my agreement, but that all claims arising during the time of   my agreement will be  subject  to  arbitration.  I  understand  that  by   signing  the  form,  I  am  deemed  to  have  received  and reviewed the   information describing arbitration that has been provided to me. I  also   understand  that  there is no requirement that I sign this form and that   my decision not to sign  this  form  will  not  in  any  way  affect  my   membership or benefits in this health maintenance organization."3.  After  receiving  the  approval of the superintendent of financial   services, pursuant to section five thousand  six  hundred  five  of  the   insurance   law,  health  maintenance  organizations  may  also  provide   arbitration election notices, as specified in subdivision  two  of  this   section, to new enrollees and their covered adult family members. In the   alternative,  a health maintenance organization may, after receiving the   superintendent's approval, elect to provide an alternative notice to new   enrollees and their covered adult family members that provides that  new   enrollees and their covered adult family members shall be subject to the   arbitration  of  claims  unless  a form is executed by such persons that   declines consent to the arbitration  of  claims.  A  health  maintenance   organization  that  chooses  to  provide  such  alternative notice shall   provide an arbitration declination form and notice to all new  enrollees   and their covered adult family members with the following provision in a   least  twelve  point  boldface  type  immediately  above  spaces for the   signature of the enrollee or covered adult family  member:  "Unless  you   sign  this  form  to  decline  the option of arbitration, by electing to   enroll in this health maintenance organization, you are agreeing to have    any issue of health care  malpractice  decided  by  neutral  arbitration   rather  than  by  a  court  trial  before  a judge or jury. (Health care   malpractice means all claims for damages  because  of  injury  or  death   resulting  from  health  care  or  treatment  rendered  or  failed to be   rendered pursuant to your health maintenance  organization  contract  by   the  health  maintenance organization, a physician, dentist, hospital or   other health care provider.) If you do not sign  this  form  to  decline   arbitration,  you will be given the opportunity to cancel your agreement   to arbitrate these claims, but all claims arising prior to the time that   you cancel the  agreement  will  be  subject  to  arbitration.  You  are   entitled  to  receive  information  describing arbitration before making   this decision. Your decision to sign this form  to  decline  arbitration   will  not  in  any way affect your membership or benefits in this health   maintenance organization."4. Arbitration election notices may be provided, from time to time, by   health maintenance organizations to  persons  who  have  not  agreed  to   arbitration  of such claims. The health maintenance organizations shall,   in a form and manner determined to be sufficient by  the  superintendent   of financial services and on at least an annual basis, provide notice to   persons  who have agreed to arbitration of such claims that such persons   may cancel their agreement to arbitrate, including information as to how   such person may cancel the  arbitration  agreement;  provided,  however,   that  the  agreement  to  arbitrate  shall  remain  in force during such   person's enrollment or membership in the health maintenance organization   unless the health maintenance organization receives notification of such   person's  cancellation  of  the  arbitration  agreement  or  the  health   maintenance  organization  withdraws  its  agreement  to  arbitrate  and   provides notice of this fact to persons who elected arbitration.5. Every such notice  shall  be  accompanied  by  or  be  part  of  an   information  brochure, prepared in accordance with section five thousand   six hundred four of the insurance law, which clearly explains the nature   and scope of arbitration and the procedures that will be used to conduct   these arbitration proceedings.6. All claims arising from surgical, medical, dental and other  health   care  procedures  performed  or  failed  to  be  performed and treatment   provided or failed to be provided by  a  physician,  dentist,  hospital,   health  maintenance  organization or other health care provider pursuant   to the enrollee contract to an enrollee or a covered adult family member   who signs the arbitration election notice  or  who  fails  to  sign  the   arbitration  declination  form  specified  in  subdivision three of this   section shall be subject to arbitration and such  enrollees  or  covered   adult  family  members shall be bound by the agreement to arbitrate such   claims.  All  physicians,  dentists,   hospitals,   health   maintenance   organizations  and  other  health  care providers who provide or receive   compensation for health care services pursuant to the enrollee  contract   shall be bound by the agreement to arbitrate.7. Notwithstanding any inconsistent provisions of law, an agreement to   arbitrate  which  complies  with the provisions of this section shall be   presumed valid.