2023 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.
(e) 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 as added by chapter 246
of  the  laws  of  2012,  that issues a comprehensive policy that uses 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 procedures for
health care professional applications and terminations  consistent  with
the  requirements  of  section four thousand eight hundred three of this
chapter and procedures for health care facility applications  consistent
with section four thousand eight hundred six of this chapter.