Bill > S08614

This bill, divided into two parts, aims to improve health equity and affordability for New Yorkers. Part A expands the Basic Health Program, a state-run health insurance plan, by allowing individuals and eligible small groups (employers with 100 or fewer employees) to purchase coverage on behalf of themselves and their qualified dependents through a "buy-in" option, provided they meet certain eligibility criteria such as residing in New York, being under 65, and not being eligible for other forms of coverage like Medicaid or child health insurance. This buy-in option is intended to make coverage more accessible and affordable, with provisions for premium subsidies and cost-sharing limits, particularly for those with lower incomes. Part B focuses on consumer protection from healthcare costs by establishing new regulations for health insurance plans, including requiring insurers to pay non-participating providers (out-of-network providers) at the insurer's median in-network rate for services and prohibiting balance billing patients for amounts above this rate. It also introduces an annual limit on a consumer's total out-of-pocket healthcare expenditures, which will include premiums, copays, coinsurance, and deductibles, regardless of whether services are in-network or out-of-network, with lower income individuals having lower annual caps.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/S8614