New York Laws
Article 2 - Organization of the Department of Financial Services
210 - Annual Consumer Guide of Health Insurers, and Entities Certified Pursuant to Article Forty-Four of the Public Health Law.

(a) The superintendent shall annually publish on or before September
first, nineteen hundred ninety-nine, and annually thereafter, a consumer
guide to insurers providing managed care products, individual accident
and health insurance or group or blanket accident and health insurance
and entities licensed pursuant to article forty-four of the public
health law providing comprehensive health service plans which includes,
in detail, a ranking from best to worst based upon each company's claim
processing or medical payments record during the preceding calendar year
using criteria available to the department, adjusted for volume of
coverage provided. Such ranking shall also take into consideration the
corresponding total number or percentage of claims denied which were
reversed or compromised after intervention by the department and the
department of health, consumer complaints to the department and the
department of health, violations of section three thousand two hundred
twenty-four-a of this chapter and other pertinent data which would
permit the department to objectively determine a company's performance.
The department in publishing such consumer guide shall publish one
state-wide guide or no more than five regional guides so as to
facilitate comparisons among individual insurers and entities within a
service market area. Such rankings shall be printed in a format which
ranks all health insurers and all entities certified pursuant to article
forty-four of the public health law in one combined list.
(b) Beginning September first, nineteen hundred ninety-nine and
annually thereafter, the superintendent shall include in such guide, and
insurers and entities certified pursuant to article forty-four of the
public health law shall provide to the superintendent the information
required for such guide in a timely fashion, the following information:
(1) The number of grievances filed pursuant to section forty-four
hundred eight-a of the public health law or article forty-eight of this
chapter and the number of such grievances in which an adverse
determination of the insurer or entity was reversed in whole or in part
versus the number of such determinations which were upheld; and
(2) The number of appeals to utilization review determinations which
were filed pursuant to article forty-nine of the public health law or
article forty-nine of this chapter and the number of such determinations
which were reversed versus the number of such determinations which were
upheld.
(c) Beginning September first, nineteen hundred ninety-nine and
annually thereafter, in addition to the information required in
subsections (a) and (b) of this section, the superintendent, in
conjunction with the commissioner of health, in consultation with the
National Committee on Quality Assurance or a similar national
organization, shall include in such guide the following additional
information, for the most recent year in which such information is
available and where applicable, for health insurers, health insurers
providing managed care products and entities certified under article
forty-four of the public health law providing comprehensive health
service plans pursuant to such article:
(1) the percentage of physicians who are either board certified or
board eligible;
(2) the percentage of primary care physicians who remained
participating providers, provided however, that such percentage shall
exclude voluntary terminations due to physician retirement, relocation
or other similar reasons;
(3) the percentage of enrollees aged twenty-three to thirty-nine and
forty to sixty-four who had one or more visits to a health plan
practitioner during the three years of their continual enrollment.
(4) the methods used to compensate primary care physicians and other
providers, provided however, that nothing in this section shall be
construed to require disclosure of the specific details of any financial
arrangement between the insurer or entity and an individual provider or
practice;
(5) the national accreditation status of insurers and entities, where
applicable;
(6) indices of the quality of care provided, such as the rates of
mammography, prostate, and cervical cancer screening, prenatal care,
well-child care, immunization and such other information collected by
the commissioner of health through the health plan employer data and
information set (HEDIS); or through the quality assurance reporting
requirements for entities not otherwise required to collect and report
health plan employer data and information set (HEDIS) data;
(7) the results of a consumer satisfaction survey among enrollees of
the various health insurers and entities, which shall be conducted by
the superintendent and commissioner of health, in consultation with the
National Committee on Quality Assurance or a similar national
organization;
(8) a toll-free telephone number for each health insurer or plan;
(9) toll-free telephone numbers at the department and the department
of health to which consumers can make complaints about insurers or
entities; and
(10) except as required in paragraph seven of this subsection, health
insurers and entities certified pursuant to article forty-four of the
public health law shall report the information required under this
subdivision to the commissioner of health, and the commissioner shall
provide such information to the superintendent for inclusion in the
annual consumer guide.
(d) Health insurers and entities certified pursuant to article
forty-four of the public health law shall provide annually to the
superintendent and the commissioner of health, and the commissioner of
health shall provide to the superintendent, all of the information
necessary for the superintendent to produce the annual consumer guide.
In compiling the guide, the superintendent shall make every effort to
ensure that the information is presented in a clear, understandable
fashion which facilitates comparisons among individual insurers and
entities, and in a format which lends itself to the widest possible
distribution to consumers. The superintendent shall either include the
information from the annual consumer guide in the consumer shopping
guide required by subsection (a) of section four thousand three hundred
twenty-three of this chapter or combine the two guides as long as
consumers in the individual market are provided with the information
required by subsection (a) of section four thousand three hundred
twenty-three of this chapter.
(e) The superintendent shall contract with a national organization for
the purposes of drafting and designing the guide, including the
preparation of relevant explanatory material. Such organization shall
have actual experience in preparing a similar guide for at least one
other state. The superintendent, in consultation with the commissioner
of health, may also contract with one or more national organizations to
assist such commissioner in the collection of data and the analysis and
auditing of the clinical measurers. Such organizations shall consult
periodically with associations representing health insurers and health

maintenance organizations as well as with consumer representatives in
New York in preparing the consumer guide.

Structure New York Laws