(a) Every issuer shall provide a health insurance identification card to the primary insured and to each dependent of the primary insured who is 18 years of age or older within 30 days of the effective date of the insured’s or dependent’s coverage, or if the insured or dependent is enrolled retroactively, within 30 days of the retroactive enrollment, under an accident and health insurance policy that provides coverage for comprehensive hospital, surgical and medical care, except coverage that is provided by this State to its employees or retirees or by governmental programs administered by the Commissioner of Health, including Medicaid, Children’s Health Insurance Program, and Essential Plan. The health insurance identification card shall, at a minimum, contain the following information:

(1) the primary insured’s name and identification number;

(2) each insured dependent’s name and, if applicable, identification number, which shall appear either on the primary insured’s identification card or on a separate card issued to the dependent;

(3) the full legal name of the issuer providing the coverage or the name under which the issuer is authorized to do business;

(4) a phrase that reads as follows: “fully insured coverage”;

(5) the plan name;

(6) the coverage type, which shall be identified as point-of-service (POS), health maintenance organization (HMO), exclusive provider organization (EPO), preferred provider organization (PPO), or fee-for-service;

(7) the name of the issuer’s health care provider network or networks for the plan, if applicable;

(8) the name of the plan’s formulary, if applicable;

(9) the phone number or numbers at which the insured or health care provider may readily obtain the following:

(i) member services assistance;

(ii) confirmation of eligibility or verification of benefits; and

(iii) prior authorization for health care services, if applicable;

(10) the internet website address of the issuer; [and]

(11) copayment or coinsurance information applicable to participating providers for the following services:

(i) primary care office visits;

(ii) specialist office visits;

(iii) urgent care;

(iv) emergency room visits; and

(v) prescription drugs for a 30-day supply at a retail pharmacy, if applicable[.];

(12) the annual or plan year deductible amount for participating providers, if applicable; and

(13) the plan’s annual maximum out-of-pocket amount.

1. Statutory authority: Financial Services Law (“FSL”) sections 202, 301, and 302 and Insurance Law (“IL”) sections 301 and 3217, and the federal No Surprises Act (the “Federal Act”).

FSL section 202 establishes the office of the Superintendent of Financial Services (“Superintendent”).

FSL sections 301 and 302 and IL section 301, in pertinent part, authorize the Superintendent to prescribe regulations interpreting the IL and to effectuate any power granted to the Superintendent in the IL, FSL, or any other law.

IL section 3217 authorizes the Superintendent to issue regulations to establish minimum standards, including standards for full and fair disclosure, for the form, content and sale of accident and health insurance policies and subscriber contracts of issuers or corporations organized under IL Articles 32 and 43 and Public Health Law Article 44.

The Federal Act, in pertinent part, requires certain information to be included on physical or electronic health insurance identification cards that are issued to insureds. It requires such cards to include any applicable annual deductible, any annual maximum out-of-pocket amount, and the telephone number and internet website address through which insureds may seek consumer assistance information, such as information related to hospitals and urgent care facilities.

2. Legislative objectives: To require issuers to include certain information on physical or electronic health insurance identification cards that are issued to insureds, such as any annual applicable deductible and any maximum out-of-pocket amount.

3. Needs and benefits: This amendment aligns with the public policy of New York and implements the legislative objectives set forth in the IL and the Federal Act by providing additional minimum standards for the content of health insurance identification cards. Disclosure of the annual or plan year deductible for participating providers and the annual maximum out-of-pocket amount will provide the insured and the insured’s health care provider with more information relating to an insured’s health plan in an easily accessible manner.

The relevant provisions of the Federal Act take effect for plan years beginning on or after January 1, 2022 and issuers are responsible for complying with the provisions regardless of whether the Department of Financial Services (“Department”) has adopted this amendment by January 1.

4. Costs: Issuers may incur compliance costs if their current health insurance identification cards do not already include the information required by this amendment, because they will need to issue new cards to insureds. However, any additional costs are a result of the Federal Act and not this amendment because this amendment implements the Federal Act.

This amendment does not impose any compliance costs on state or local governments or health care providers.

5. Local government mandates: This amendment does not impose any program, service, duty or responsibility upon a county, city, town, village, school district, fire district, or other special district.

6. Paperwork: This amendment may require an issuer to print and distribute new health insurance identification cards. However, this is a result of the Federal Act and not this amendment. This amendment does not impose any new reporting requirements, including forms or other paperwork.

7. Duplication: This amendment does not duplicate, overlap, or conflict with any existing state or federal rules or other legal requirements.

8. Alternatives: Section 52.69 of 11 NYCRR 52 (Insurance Regulation 62) already requires health insurance identification cards to include a phone number or numbers at which an insured or health care provider may readily obtain member assistance services, confirmation of eligibility or verification of benefits, and prior authorization for health care services, as well as the issuer’s internet website address. The Federal Act imposes additional requirements, including requiring such cards to contain a telephone number and internet website address through which insureds may seek consumer assistance information, such as information related to hospitals and urgent care facilities. The Department considered whether it should require the identification card to include an additional telephone number or issuer website address. However, the Department determined that the telephone numbers and website address already required under Section 52.69 would satisfy the requirements of the Federal Act. Additionally, an issuer may disclose one telephone number and one website address on such cards to satisfy all the requirements set forth above if such number provides insureds with consumer assistance, member assistance services, confirmation of eligibility or verification of benefits, and prior authorization for health care services.

9. Federal standards: The amendment does not exceed any minimum standards of the federal government for the same or similar subject areas.

10. Compliance schedule: Issuers will need to comply with the amendment 30 days after the publication of the notice of adoption in the State Register. In addition, issuers will need to comply with the requirements of the Federal Act for policies and contracts issued, renewed, modified, or amended on or after January 1, 2022, regardless of the effective date of this amendment.

1. Effect of rule: This amendment to the regulation applies to insurers licensed to write accident and health insurance in New York State, corporations organized pursuant to Insurance Law Article 43, municipal cooperative health benefit plans certified pursuant to Insurance Law Article 47, health maintenance organizations certified pursuant to Public Health Law Article 44, and student health plans certified pursuant to Insurance Law Section 1124 (collectively, “issuers”). Although most issuers do not come within the definition of “small business” as defined in State Administrative Procedure Act (“SAPA”) Section 102(8) because they generally are not both independently owned and have fewer than 100 employees, industry has asserted previously that certain issuers, in particular mutual insurers, subject to the regulation are small businesses but has not provided the Department of Financial Services (“Department”) with specific insurers or the number of such entities. The amendment does not apply to local governments.

2. Compliance requirements: Any issuer that is a small business affected by this amendment will be required to include the annual or plan year deductible amount for participating providers, if applicable, and the annual maximum out-of-pocket amount on the health insurance identification cards that it provides to insureds. However, this is a result of the Federal Act and not this amendment.

No local government will have to undertake any reporting, recordkeeping, or other affirmative acts to comply with the amendment.

3. Professional services: An issuer that is a small business affected by this amendment will not need to retain professional services, such as lawyers or auditors, to comply with this amendment.

4. Compliance costs: No local government will incur any costs to comply with this amendment because the amendment does not apply to any local government.

An issuer that is a small business may incur compliance costs if it needs to print and distribute new health insurance identification cards to include the information required by this amendment and the Federal Act. However, any additional compliance costs incurred are a result of the Federal Act and not this amendment because the amendment implements the Federal Act.

5. Economic and technological feasibility: No issuer that is a small business affected by this amendment should experience any economic or technological impact as a result of the amendment.

6. Minimizing adverse impact: There will not be an adverse impact on any local government because the amendment does not apply to any local government. This amendment should not have an adverse impact on an issuer that is a small business because the amendment uniformly affects all issuers. However, to the extent there is an adverse impact on an issuer that is a small business, it is a result of the Federal Act and not this amendment because this amendment implements the Federal Act.

7. Small business and local government participation: The Department complied with SAPA Section 202-b(6) by notifying representatives of issuers that are small businesses that it intended to promulgate this amendment. The Department also posted the regulation on its website for comment by interested parties, such as issuers that are small businesses, and the public. Issuers that are small businesses also will have an opportunity to participate in the rulemaking process again when the amendment is published in the State Register and posted on the Department’s website.

1. Types and estimated numbers of rural areas: Insurers licensed to write accident and health insurance in New York State, corporations organized pursuant to Insurance Law Article 43, municipal cooperative health benefit plans certified pursuant to Insurance Law Article 47, health maintenance organizations certified pursuant to Public Health Law Article 44, and student health plans certified pursuant to Insurance Law Section 1124 (collectively, “issuers”) affected by this amendment operate in every county in New York State, including rural areas as defined by State Administrative Procedure Act Section 102(10).

2. Reporting, recordkeeping, and other compliance requirements; and professional services: This amendment does not impose any new reporting, recordkeeping, or other compliance requirements, other than those that are a result of the federal No Surprises Act, on regulated entities. Regulated parties may be required to include additional information on their health insurance identification cards.

Issuers, including those in a rural area, should not need to retain professional services, such as lawyers or auditors, to comply with this amendment.

3. Costs: Issuers may incur compliance costs if their current health insurance identification cards do not already include the information required by this amendment, because they will need to issue new identification cards to insureds. However, any additional costs are a result of the Federal Act and not this amendment because this amendment implements the Federal Act.

This amendment does not impose any compliance costs on state or local governments or health care providers.

4. Minimizing adverse impact: This amendment uniformly affects issuers that are located in both rural and non-rural areas of New York State. The amendment should not have an adverse impact on rural areas.

5. Rural area participation: The Department of Financial Services (“Department”) notified trade associations representing issuers that are in rural areas that it intended to promulgate this amendment. Issuers in rural areas will have an opportunity to participate in the rulemaking process when the amendment is published in the State Register and posted on the Department’s website.

The Department of Financial Services finds that this amendment to 11 NYCRR 52 will not adversely impact jobs or employment opportunities in this state. The amendment merely implements the federal No Surprises Act by setting forth additional minimum standards for the content of health insurance identification cards, including disclosure of the annual or plan year deductible for participating providers and the annual maximum out-of-pocket amount.