Judy Kamens Compliance Specialist View Bio

Healthcare Reform

Click here to download this document: New York Health Insurance Mandates

Health Insurance Mandates

State health insurance mandates are laws regulating the terms of coverage for insured health plans. Mandates can affect various parts of health insurance plans as follows:

  • Benefit mandates require health insurance plans to cover specific treatments, services or procedures. In some cases, however, benefit mandates require issuers to offer coverage for specific services or procedures to employers.
  • Provider mandates require health insurance plans to pay for services provided by specific health care professionals. Often, provider mandates are in the form of nondiscrimination mandates that require coverage only if the health plan already reimburses services within the scope of the health care professional’s practice.
  • Person mandates require health insurance plans to cover specific categories of people.

Additional mandates for health plans exist at the federal level. For instance, the Affordable Care Act (ACA) requires non-grandfathered plans in the small group and individual markets to provide coverage for items and services designated as “essential health benefits.” Health plan sponsors and issuers should work with their advisors to determine how to comply with applicable federal and state mandates.

This Employment Law Summary contains a chart outlining New York’s benefit, provider and person mandates for insured group health plans issued in the state. Please keep in mind that the following chart does not address federal benefit mandates, such as the ACA’s mandates.

State Resources

  • New York Department of Financial Services website
  • New York’s state insurance laws can be found here
  • State mandated benefits for comprehensive health insurance contracts can be found here

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