NY S01803

Requires individual and group health insurance policies that cover dialysis to provide coverage for out-of-network dialysis treatment when medically necessary and conditions are met, even if the policy normally requires in-network providers.

Out-of-network dialysis coverage is limited to no more than 10 treatments per calendar year and requires 30 days' written advance notice to the insurer (or shorter notice in emergencies), a written order from the patient's treating provider, and insurer pre-approval.

Insurers may only reimburse out-of-network dialysis providers at the same rate they would pay for in-network treatment; any amount charged above this rate is the patient's responsibility.

Out-of-network dialysis coverage remains subject to standard policy limitations including deductibles, copayments, coinsurance, and utilization review requirements.

Applies the same coverage requirements to health service corporations and hospital service corporations; effective January 1st following enactment.