Bill > S04122

This bill clarifies and amends provisions of the New York state health insurance program, specifically focusing on out-of-network health care service reimbursement and benefits. The bill mandates that health benefits must include reimbursement of at least 80% of the "usual and customary cost" for out-of-network health care services, which is defined as the eightieth percentile of charges for a particular health care service performed by a provider in the same or similar specialty within the same geographical area, as reported in a benchmarking database maintained by a specified nonprofit organization. Additionally, the bill ensures that when health benefits are extended to employees not originally covered by a specific agreement, these benefits cannot diminish existing current benefits. The legislation aims to provide more transparent and consistent health insurance coverage for state employees by explicitly defining reimbursement standards and protecting the comprehensiveness of health care benefits.

Labor and Employment

https://www.nysenate.gov/legislation/bills/2025/S4122