§ 3217-d. Grievance procedure and access to specialty care.
(a)An\ninsurer that issues a comprehensive policy that utilizes a network of\nproviders and is not a managed care health insurance contract as defined\nin subsection (c) of section four thousand eight hundred one of this\nchapter shall establish and maintain a grievance procedure consistent\nwith the requirements of section four thousand eight hundred two of this\nchapter.\n (b) An insurer that issues a comprehensive policy that utilizes a\nnetwork of providers and is not a managed care health insurance contract\nas defined in subsection (c) of section four thousand eight hundred one\nof this chapter and requires that specialty care be provided pursuant to\na referral from a primary care provider shall provide access to such\n
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§ 3217-d. Grievance procedure and access to specialty care. (a) An\ninsurer that issues a comprehensive policy that utilizes a network of\nproviders and is not a managed care health insurance contract as defined\nin subsection (c) of section four thousand eight hundred one of this\nchapter shall establish and maintain a grievance procedure consistent\nwith the requirements of section four thousand eight hundred two of this\nchapter.\n (b) An insurer that issues a comprehensive policy that utilizes a\nnetwork of providers and is not a managed care health insurance contract\nas defined in subsection (c) of section four thousand eight hundred one\nof this chapter and requires that specialty care be provided pursuant to\na referral from a primary care provider shall provide access to such\nspecialty care consistent with the requirements of subsections (b), (c)\nand (d) of section four thousand eight hundred four of this chapter;\nprovided, however, that nothing in this section shall be construed to\nrequire that an insurer, or a primary care provider on behalf of the\ninsurer, make a referral to a provider that is not in the insurer's\nnetwork.\n (c) An insurer that issues a comprehensive policy that utilizes a\nnetwork of providers and is not a managed care health insurance contract\nas defined in subsection (c) of section four thousand eight hundred one\nof this chapter shall provide access to transitional care consistent\nwith the requirements of subsections (e) and (f) of section four\nthousand eight hundred four of this chapter.\n (d) An insurer that issues a comprehensive policy that utilizes a\nnetwork of providers and is not a managed care health insurance contract\nas defined in subsection (c) of section four thousand eight hundred one\nof this chapter, shall provide access to out-of-network services\nconsistent with the requirements of subsection (a) of section four\nthousand eight hundred four of this chapter, subsections (g-6) and (g-7)\nof section four thousand nine hundred of this chapter, subsections (a-1)\nand (a-2) of section four thousand nine hundred four of this chapter,\nparagraphs three and four of subsection (b) of section four thousand\nnine hundred ten of this chapter, and subparagraphs (C) and (D) of\nparagraph four of subsection (b) of section four thousand nine hundred\nfourteen of this chapter.\n (e) An insurer that issues a comprehensive policy that uses a network\nof providers and is not a managed care health insurance contract, as\ndefined in subsection (c) of section four thousand eight hundred one of\nthis chapter, shall establish and maintain procedures for health care\nprofessional applications and terminations consistent with the\nrequirements of section four thousand eight hundred three of this\nchapter and procedures for health care facility applications consistent\nwith section four thousand eight hundred six of this chapter.\n