Dfs.ny.gov

New York Consumer Guide to Health Insurers

Health insurance companies that were in operation during the entire 2017 calendar year were required to report DOH data. • Health insurance companies are listed alphabetically in the data tables, except for the Overall Complaint Ranking table on pages 60–63. • Some health insurance companies are …

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URL: https://www.dfs.ny.gov/consumers/health_insurance/guide_2019

Health Insurers: Guidance Regarding the Federal Health

(6 days ago) N.Y. Pub. Health Law § 4406(1); and 11 NYCRR 360.3(a)(1)(ii).) Limitations and prohibitions on minimum participation requirements are described below. HMOs – Health maintenance organizations may not impose minimum participation requirements in the large group or small group markets.

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The New York State Department of Financial Services …

(9 days ago) health and substance use disorder and failure to provide comparable reimbursement for evaluation and management claims submitted by psychiatrists when the underlying service is provided in the course of treatment of a mental illness or substance use disorder. Response: The Department reviewed the suggested amendments but does not believe it is

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ACCIDENT AND HEALTH INSURERS FILING ON THE …

(9 days ago) Mr. Thomas Dudek, Health Bureau New York State Department of Financial Services One State Street New York, NY 10004 Q. Certificate of Deposit: Mr. Thomas Dudek, Health Bureau New York State Department of Financial Services One State Street New York, NY 10004 R. Certificate of Valuation: Mr. Thomas Dudek, Health Bureau

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Health Provider, Assumption of Risk Department of

(Just Now) The Office of General Counsel issued the following informal opinion on April 4, 2000, representing the position of the New York State Insurance Department. Re: Health Provider, Assumption of Risk Question Presented: May a health care provider assume risk from a Health Maintenance Organization? Conclusion: Yes, if the health care provider is in compliance with applicable statutes and regulations.

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New York State Department of Financial Services

(6 days ago) coverage under such policies; offered for sale a “tailor-made” student blanket health insurance policy prior to obtaining approval of the language and rate for each benefit provision of the policy; and solicited and enrolled students prior to approval of the student blanket health insurance program. [Stipulation approved March 8, 2016.]

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United Healthcare Montefiore Contract Dispute Department

(5 days ago) Fully-insured large group, small group and individual health plans: Montefiore physicians will be out-of-network, effective Jan. 1, 2021. Montefiore hospitals will be out-of-network, effective March 1, 2021. Employer-sponsored self-insured (ASO) coverage: Montefiore physicians and hospitals will be out-of-network, effective Jan. 1, 2021.

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Insurance Circular Letter No. 4 (2021): Administrative

(7 days ago) The purpose of this circular letter is to advise insurers authorized to write accident and health insurance in New York State, article 43 corporations, health maintenance organizations, student health plans certified pursuant to Insurance Law § 1124, municipal cooperative health benefit plans, and prepaid health services plans (collectively

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HealthPlus HP, LLC

(7 days ago) HealthPlus HP, LLCHealthPlus HP, LLC. Pending Applications. Applications Under Review. IND-BOTHX-HMO. Approved Applications (by Effective Date) Effective January 1, 2021. IND-BOTHX-HMO. Effective January 1, 2020. IND-BOTHX-HMO.

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Independent Dispute Resolution and Exempt CPT Codes

(8 days ago) Health plan pays the cost of the dispute resolution when the IDRE determines that the provider's fee is reasonable. Provider and the health plan share the prorated cost when there is a settlement. There may be a minimal fee to the provider or health plan submitting the …

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Health Insurers: Network Adequacy Standards and Guidance

(3 days ago) Network Adequacy Standards and Guidance. Section 3241 of the Insurance Law requires insurers, including municipal cooperative health benefit plans and student health plans, that issue a health insurance policy or contract or a dental policy or contract with a network of providers to ensure that the network is adequate to meet the health needs of insureds and provide an appropriate choice of

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2020 Health Maintenance Organizations Annual Statement and

(8 days ago) The Health Maintenance Organization Annual Statement Checklist & Instructions provides filing requirements for submission to the NAIC and the Department of Financial Services. This website also provides specific instructions for filing the New York Supplement and supplemental forms with DFS. HMOs subject to these filing requirements are

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Emergency Physician and Hospital Services IDR Q&A

(5 days ago) The health care plan should pay an amount that it determines is reasonable for the services rendered, under Financial Services Law § 605(a), except for the insured’s in-network copayment, coinsurance, or deductible, if any. The health care plan would not have to pay …

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Health Insurance Coverage, Domestic Partners Department

(Just Now) Pursuant to New York Public Health Law §4406 (McKinney 2001), New York Insurance Law §4305 (c) (1) is also applicable to group contracts issued by Health Maintenance Organizations. The New York Insurance Law does not prohibit coverage of domestic partners, provided there is a showing of economic, as opposed to emotional, dependence.

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UR Minimum Process Requirements for Retrospective

(4 days ago) behavioral health and has experience in the delivery of mental health treatment and, where applicable, possesses a current and valid non-restricted license, certificate, or registration, or if none exists, is credentialed by the national accrediting body appropriate to the profession. Licensed Health Care Professional or Clinical Peer. Medical

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Employer Sponsored Health Insurance Department of

(Just Now) The provision of health insurance by an employer constitutes a welfare benefit plan as that term is defined under the Employee Retirement Income Security Act (ERISA). 29 U.S.C.A. § …

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Health Insurance Portability and Accountability Act (HIPAA

(Just Now) HIPAA, Pub. L. 104-191 ( 1996), is a comprehensive enactment by the United States Congress concerning health care and imposes substantive requirements on, inter alia, insurers. The New York Insurance Law (McKinney 2000 and 2003 Supplement) was substantially amended to bring it into compliance with HIPAA. HIPAA is composed of a number of Titles

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Mental Health and Substance Use Disorder Information

(1 days ago) Mental Health and Substance Use Disorder Coverage Covered by New York Protections. New York protections apply to individual coverage bought in New York through the New York State of Health Marketplace or from a broker or an insurer in New York and group coverage an employer may buy in New York from an insurer in New York.

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Parent’s Access to Child’s Health Information, Health

(4 days ago) Health information means any information, whether oral or recorded in any form or medium, that: (1) Is created or received by a health care provider, health plan, public health authority, . . . or health care clearinghouse; and (2) Relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present

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BlueCross BlueShield of Western New York (a division of

(Just Now) Health insurance premiums have continually risen at a rapid rate over the past ten years. With each increase, people such as myself are forced to make financial sacrifices in order to maintain coverage. Further the rising rates are coupled with less coverage. I …

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Prompt Pay Department of Financial Services

(4 days ago) 1. N.Y. Ins. Law § 3224-a (McKinney 2000) requires payment of health claims by health insurance companies within 45 days of receipt of such claim; N.Y. Ins. Law § 5106 (McKinney 2000) requires motor vehicle no-fault providers to pay health claims arising from vehicular accidents to be paid within 30 days of receipt of such claim. 2.

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Group Health Insurance: Coverage of New York Residents

(Just Now) Comprehensive health services means all those health services which an enrolled population might require in order to be maintained in good health, and shall include, but shall not be limited to, physician services (including consultant and referral services), in-patient and out-patient hospital services, diagnostic laboratory and therapeutic

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Circular Letter No. 4 (2004): Health Savings Accounts and

(7 days ago) An HDHP is defined as a health insurance plan which has an annual deductible of at least $1,000 and an annual out-of-pocket expense maximum of no more than $5,000 for self-coverage and an annual deductible of $2,000 and an annual out of-pocket maximum of no more than $10,000 for family coverage.

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Health Insurers: Network Adequacy Submission Instructions

(3 days ago) The primary purpose of the PNDS is to collect the data needed to evaluate provider networks, including physicians, hospitals, labs, home health agencies, durable medical equipment providers, etc. for all health insurers in New York State.

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OGC Opinion No. 04-12-32: Use of Extrapolation

(4 days ago) In the processing of all health care claims submitted under contracts or agreements issued or entered into pursuant to articles . . . forty-two . . . of this chapter and article forty-four of the public health law and all bills for health care services rendered by health care providers pursuant to such contracts or agreements, any insurer . . . or corporation licensed or certified pursuant to

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UR Minimum Process Requirements for Prior Authorization

(4 days ago) behavioral health and has experience in the delivery of mental health treatment; or (2) a health care professional other than a physician who specializes in behavioral health and has experience in the delivery of mental health treatment and, where applicable, possesses a current and valid non-restricted license, certificate, or registration, or

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OGC Opinion No. 09-01-04: Employers’ Trust for Health

(4 days ago) OGC Op. No. 09-01-04 The Office of General Counsel issued the following opinion on January 13, 2009 representing the position of the New York State Insurance Department. RE: Employers’ Trust for Health Insurance Questions Presented: 1) May a group of not-for-profit educational institutions form a trust for the purpose of self-funding health insurance benefits for the employees of the …

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Mental Health and Substance Use Disorder Parity Reports

(1 days ago) Mental Health and Substance Use Disorder Parity Reports. The recent Mental Health and Substance Use Disorder Parity Report Act requires health insurers to submit information to the Department of Financial Services (DFS) to help measure compliance with federal and state parity laws for mental health and substance use disorder treatment.

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Group Accident & Health Insurance, Sole Proprietors

(Just Now) The Office of General Counsel issued the following opinion on April 4, 2003, representing the position of the New York State Insurance Department. Re: Group Accident & Health Insurance, Sole Proprietors Questions Presented: 1) Is the coverage authorized by 2002 N.Y. Laws 557 considered group coverage? 2) Would purchase of such coverage affect eligibility for Medicare?

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HealthPlus HP, LLC Individual 2021 Public Comments

(9 days ago) Health Plus Gatekeeper X for HSA bronze, ST, INN, pediatric dental, DEP 25. It is insane that they want to raise what is already a high rate even higher. The deductibles are insane, the monthly rates are insane. Shame on them!! To make decent health insurance even further out of reach for everyday middle income New Yorkers is unfair and greedy

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OGC Opinion No. 05-04-13: Health Insurance, Recoupment of

(Just Now) The Office of General Counsel issued the following opinion on April 14, 2005 representing the position of the New York State Insurance Department. Re: Health Insurance, Recoupment of Overpayment Issues 1. Did the health insurer covering an insured and the insured's dependents properly pay certain claims of the insured's domestic partner as if such insurer were the primary insurer?

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OGC Opinion No. 05-09-10: Audit of Health Insurance Claims

(Just Now) 1. With respect to participating healthy care providers, the contract between the health care provider and the insurer, including a Health Maintenance Organization, would control how far back the insurer could audit claims. With respect to non-participating health care providers, there is no provision in the New York Insurance Law (McKinney

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OGC Opinion No. 05-09-11: Health Insurance External

(Just Now) A Regulation of the Department of Health, N.Y. Comp. Codes . & Regs. tit. 10, § 98-2.7(a)(6) (2001) has an identical requirement. The statutes, which contemplate swift resolution of these issues, do not provide either the Superintendent of Insurance or the Commissioner of Health with the discretion to extend or waive the applicable time limit.

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Insurance Circular Letter No. 11 (2020): COVID-19 Testing

(7 days ago) The purpose of this circular letter is to advise insurers authorized to write accident and health insurance in this state, Article 43 corporations, health maintenance organizations, student health plans certified pursuant to Insurance Law § 1124, municipal cooperative health benefit plans, and prepaid health services plans (collectively

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Adoption of Insurance Regulation 218 (11 NYCRR 230

(5 days ago) mental health or substance use disorder providers are effective in reducing disparities in out-of-network use and to ensure there is an adequate network of mental health and substance use disorder providers to provide services on an in-network basis; (iv) review of provider credentialing policies and procedures to ensure that the documentation and

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Financial Examination Report 12/31/2016 of American Pet

(9 days ago) The Company began writing pet health insurance in January 2008 under the brand name Trupanion and managed by its affiliate TMUI, an Arizona corporation. Capital paid in is $4,800,000 consisting of 1,600 shares of $3,000 par value per share common stock. Gross paid in …

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Coronavirus (COVID-19) information: Health Insurance FAQs

(6 days ago) NY Coverage. If you have individual or group health insurance coverage that you or your employer bought in New York, including through the NY State of Health Marketplace or the New York State Health Insurance Program (NYSHIP) for public employees, you are covered for the testing and treatment for novel coronavirus (COVID-19) as described below.

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DFS Diversity, Equity and Inclusion Webinar Department

(Just Now) Prior to joining EmblemHealth in 2015, Ms. Ignagni was President and CEO of America’s Health Insurance Plans (AHIP), the insurance industry association that represents providers of health and supplemental benefits to more than 200 million Americans. Under her leadership, AHIP became the leading voice for the health plan community.

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Insurance Circular Letter No. 13 (2018): Preauthorization

(9 days ago) Insurance Circular Letter No. 13 (2018) September 19, 2018 TO: All Insurers Authorized to Write Accident and Health Insurance in New York State, Article 43 Corporations, Health Maintenance Organizations (“HMOs”), Student Health Plans Certified Pursuant to Insurance Law § 1124, and Municipal Cooperative Health Benefit Plans

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Customer Health FAQ Department of Financial Services

(8 days ago) The Department of Financial Services maintains and updates a list of insurance companies that issue Medicare supplement (“Medigap”) insurance policies in the state of New York. The names, addresses and telephone numbers of the insurance companies offering Medigap coverage can be found in our New York Health Insurance Policies & Programs

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OGC Opinion No. 07-11-01: Prepaid Health Service Plans

(4 days ago) The Health Department considers PHSPs to be managed care organizations (“MCOs”), N.Y. Comp. Codes R. & Regs tit. 10, § 98-1.2(x) (2005). An MCO may pay commissions pursuant to 10 NYCRR § 98-1.11(t) to a licensed insurance agent or broker, provided that the MCO also is in compliance with N.Y. Ins. Law § 4312 (McKinney 2007).

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OGC Opinion No. 05-08-10: Out of Network Health Coverage

(Just Now) requires, or provides financial incentives for, the insured to receive covered services from health care providers participating in a provider network maintained by or under contract with the insurer, the policy shall include coverage for a second medical opinion from a non-participating specialist . . . at no additional cost to the insured beyond what such insured would have paid for services

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Circular Letter No. 7 (2005): Explanation of Benefits (EOB

(7 days ago) Circular Letter No. 7 (2005) March 24, 2005 TO: All Insurers Licensed to Write Accident and Health Insurance in New York State ( Commercial Insurers ), Article 43 Corporations and Health Maintenance Organizations RE: Explanation of Benefits (EOB) Requirements

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