§ 4306-C — Grievance procedure and access to specialty care

§ 4306-c. Grievance procedure and access to specialty care. (a) A\ncorporation, including a municipal cooperative health benefits plan\ncertified pursuant to article forty-seven of this chapter, that issues a\ncomprehensive contract that utilizes a network of providers and is not a\nmanaged care health insurance contract as defined in subsection (c) of\nsection four thousand eight hundred one of this chapter shall establish\nand maintain a grievance procedure consistent with the requirements of\nsection four thousand eight hundred two of this chapter.\n (b) A corporation, including a municipal cooperative health benefits\nplan certified pursuant to article forty-seven of this chapter, that\nissues a comprehensive contract that utilizes a network of providers and\nis not a managed care health insurance contract as defined in subsection\n(c) of section four thousand eight hundred one of this chapter and\nrequires that specialty care be provided pursuant to a referral from a\nprimary care provider shall provide access to such specialty care\nconsistent with the requirements of subsections (b), (c) and (d) of\nsection four thousand eight hundred four of this chapter; provided\nhowever, that nothing in this section shall be construed to require that\na corporation, or a primary care provider on behalf of the corporation,\nmake a referral to a provider that is not in the corporation's network.\n (c) A corporation, including a municipal cooperative health benefits\nplan certified pursuant to article forty-seven of this chapter, that\nissues a comprehensive contract that utilizes a network of providers and\nis not a managed care health insurance contract as defined in subsection\n(c) of section four thousand eight hundred one of this chapter shall\nprovide access to transitional care consistent with the requirements of\nsubsections (e) and (f) of section four thousand eight hundred four of\nthis chapter.\n (d) A corporation, including a municipal cooperative health benefit\nplan certified pursuant to article forty-seven of this chapter and a\nstudent health plan established or maintained pursuant to section one\nthousand one hundred twenty-four of this chapter, that issues a\ncomprehensive policy that utilizes a network of providers and is not a\nmanaged care health insurance contract as defined in subsection (c) of\nsection four thousand eight hundred one of this chapter, shall provide\naccess to out-of-network services consistent with the requirements of\nsubsection (a) of section four thousand eight hundred four of this\nchapter, subsections (g-6) and (g-7) of section four thousand nine\nhundred of this chapter, subsections (a-1) and (a-2) of section four\nthousand nine hundred four of this chapter, paragraphs three and four of\nsubsection (b) of section four thousand nine hundred ten of this\nchapter, and subparagraphs (C) and (D) of paragraph four of subsection\n(b) of section four thousand nine hundred fourteen of this chapter.\n (e) A corporation, including a municipal cooperative health benefit\nplan certified pursuant to article forty-seven of this chapter and a\nstudent health plan established or maintained pursuant to section one\nthousand one hundred twenty-four of this chapter as added by chapter 246\nof the laws of 2012, that issues a comprehensive policy that uses a\nnetwork of providers and is not a managed care health insurance\ncontract, as defined in subsection (c) of section four thousand eight\nhundred one of this chapter, shall establish and maintain procedures for\nhealth care professional applications and terminations consistent with\nthe requirements 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