NY S08614

Expands New York's Basic Health Program to allow individuals above 200% of the federal poverty line and small groups (employers with 100 or fewer employees) to "buy-in" by paying the regional per-member, per-month premium rate

Eliminates deductibles for all Basic Health Program enrollees and caps cost-sharing at a maximum of $200 per covered service, with no cost-sharing for those with household incomes at or below 500% of the federal poverty line

Requires all hospitals, mental health facilities, and ambulatory surgery centers licensed in New York to make covered services available to Basic Health Program enrollees and negotiate network participation in good faith

Establishes new out-of-network payment rules requiring health plans to pay non-participating providers the median in-network rate and prohibiting providers from balance billing patients above that amount

Creates annual caps on total consumer health care expenditures including premiums, copays, coinsurance, and deductibles for both in-network and out-of-network services, with caps varying by household income and not exceeding double the IRS Employer Health Plan Affordability Threshold