NY A09539

Requires all health insurance policies providing hospital, surgical, medical, or major medical coverage to cover medically necessary services from an out-of-network provider of the patient's choice for rare diseases, life-threatening conditions, degenerative and disabling conditions, or medically fragile children diagnoses.

Imposes three conditions for out-of-network coverage: the chosen provider's costs must equal or be less than the average cost of a comparable in-network specialist; the patient's treating specialist or primary care provider must provide written recommendation; and the chosen provider must be accredited or designated by state/federal health authorities or voluntary national health organizations with expertise in the specific diagnosis.

Requires advance notice to the insurance plan from the chosen provider or patient's primary care physician prior to any planned procedure covered under this provision.

Clarifies that insurers are not required to cover travel costs to the chosen provider and that the chosen provider need not be in-network or located within New York State.

Takes effect 90 days after becoming law and applies to all insurance policies issued, renewed, modified, altered, or amended on or after the effective date.