NY Ins L § 210 (2021)
2021 New York Laws ISC - Insurance Article 2 - Organization of the Department of Financial Services 210 - Annual Consumer Guide of Health Insurers, and Entities Certified Pursuant to Article Forty-Four of the Public Health Law.

§  210.  Annual  consumer  guide  of  health  insurers,  and  entities certified pursuant to article forty-four of the public health law.  (a) The superintendent shall annually publish on or  before  September first, nineteen hundred ninety-nine, and annually thereafter, a consumer guide  to  insurers providing managed care products, individual accident and health insurance or group or blanket accident and  health  insurance and  entities  licensed  pursuant  to  article  forty-four of the public health law providing comprehensive health service plans which  includes, in  detail, a ranking from best to worst based upon each company's claim processing or medical payments record during the preceding calendar year using criteria available to  the  department,  adjusted  for  volume  of coverage  provided.  Such ranking shall also take into consideration the corresponding total number or percentage of  claims  denied  which  were reversed  or  compromised  after  intervention by the department and the department of health, consumer complaints  to  the  department  and  the department  of  health, violations of section three thousand two hundred twenty-four-a of this chapter  and  other  pertinent  data  which  would permit  the department to objectively determine a company's performance. The department in publishing  such  consumer  guide  shall  publish  one state-wide  guide  or  no  more  than  five  regional  guides  so  as to facilitate comparisons among individual insurers and entities  within  a service  market  area.  Such rankings shall be printed in a format which ranks all health insurers and all entities certified pursuant to article forty-four of the public health law in one combined list.  (b)  Beginning  September  first,  nineteen  hundred  ninety-nine  and annually thereafter, the superintendent shall include in such guide, and insurers  and  entities  certified pursuant to article forty-four of the public health law shall provide to the  superintendent  the  information required for such guide in a timely fashion, the following information:  (1)  The  number  of  grievances  filed pursuant to section forty-four hundred eight-a of the public health law or article forty-eight of  this chapter   and  the  number  of  such  grievances  in  which  an  adverse determination of the insurer or entity was reversed in whole or in  part versus the number of such determinations which were upheld; and  (2)  The  number of appeals to utilization review determinations which were filed pursuant to article forty-nine of the public  health  law  or article forty-nine of this chapter and the number of such determinations which  were reversed versus the number of such determinations which were upheld.  (c)  Beginning  September  first,  nineteen  hundred  ninety-nine  and annually   thereafter,  in  addition  to  the  information  required  in subsections  (a)  and  (b)  of  this  section,  the  superintendent,  in conjunction  with  the  commissioner of health, in consultation with the National  Committee  on  Quality  Assurance  or   a   similar   national organization,  shall  include  in  such  guide  the following additional information, for the most recent  year  in  which  such  information  is available  and  where  applicable,  for health insurers, health insurers providing managed care products and  entities  certified  under  article forty-four  of  the  public  health  law  providing comprehensive health service plans pursuant to such article:  (1) the percentage of physicians who are  either  board  certified  or board eligible;  (2)   the   percentage   of   primary  care  physicians  who  remained participating providers, provided however, that  such  percentage  shall exclude  voluntary  terminations due to physician retirement, relocation or other similar reasons;  (3) the percentage of enrollees aged twenty-three to  thirty-nine  and forty  to  sixty-four  who  had  one  or  more  visits  to a health plan practitioner during the three years of their continual enrollment.  (4)  the  methods used to compensate primary care physicians and other providers, provided however, that  nothing  in  this  section  shall  be construed to require disclosure of the specific details of any financial arrangement  between the insurer or entity and an individual provider or practice;  (5) the national accreditation status of insurers and entities,  where applicable;  (6)  indices  of  the  quality  of care provided, such as the rates of mammography, prostate, and cervical  cancer  screening,  prenatal  care, well-child  care,  immunization  and such other information collected by the commissioner of health through the health  plan  employer  data  and information  set  (HEDIS);  or  through  the quality assurance reporting requirements for entities not otherwise required to collect  and  report health plan employer data and information set (HEDIS) data;  (7)  the  results of a consumer satisfaction survey among enrollees of the various health insurers and entities, which shall  be  conducted  by the  superintendent and commissioner of health, in consultation with the National  Committee  on  Quality  Assurance  or   a   similar   national organization;  (8) a toll-free telephone number for each health insurer or plan;  (9)  toll-free  telephone numbers at the department and the department of health to which consumers  can  make  complaints  about  insurers  or entities; and  (10)  except as required in paragraph seven of this subsection, health insurers and entities certified pursuant to article  forty-four  of  the public  health  law  shall  report  the  information required under this subdivision to the commissioner of health, and  the  commissioner  shall provide  such  information  to  the  superintendent for inclusion in the annual consumer guide.  (d)  Health  insurers  and  entities  certified  pursuant  to  article forty-four  of  the  public  health  law  shall  provide annually to the superintendent and the commissioner of health, and the  commissioner  of health  shall  provide  to  the  superintendent,  all of the information necessary for the superintendent to produce the annual  consumer  guide. In  compiling  the  guide, the superintendent shall make every effort to ensure that the information is  presented  in  a  clear,  understandable fashion  which  facilitates  comparisons  among  individual insurers and entities, and in a format which lends  itself  to  the  widest  possible distribution  to  consumers. The superintendent shall either include the information from the annual consumer  guide  in  the  consumer  shopping guide  required by subsection (a) of section four thousand three hundred twenty-three of this chapter or  combine  the  two  guides  as  long  as consumers  in  the  individual  market are provided with the information required by subsection  (a)  of  section  four  thousand  three  hundred twenty-three of this chapter.  (e) The superintendent shall contract with a national organization for the  purposes  of  drafting  and  designing  the  guide,  including  the preparation of relevant explanatory material.  Such  organization  shall have  actual  experience  in  preparing a similar guide for at least one other state. The superintendent, in consultation with  the  commissioner of  health, may also contract with one or more national organizations to assist such commissioner in the collection of data and the analysis  and auditing  of  the  clinical  measurers. Such organizations shall consult periodically with associations representing health insurers  and  health  maintenance  organizations  as  well as with consumer representatives in New York in preparing the consumer guide.