2023 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.