New York Assembly Bill A08500

New York 2025-2026 Regular Session

• Introduced: 5/20/25
• Refer: 5/20/25
• Refer: 1/7/26

Caption

Clarifies that the New York state health insurance program remains subject to certain provisions of the financial services law and coverage for usual and customary costs for out-of-network health care service.

Summary

This bill amends the Civil Service Law to clarify how health insurance coverage under the New York State Health Insurance Program (NYSHIP) must be administered. It states that mandated health insurance coverage, including coverage required under the Insurance Law, must be provided without interruption and adds a specific requirement that out-of-network health care services be reimbursed at no less than 80 percent of the usual and customary cost. The bill defines “usual and customary cost” as the 80th percentile of charges for the same or similar specialty in the same geographic area, based on a benchmarking database designated by the Superintendent of Financial Services. The bill also amends provisions governing health benefits negotiated through collective bargaining agreements for state employees. It authorizes the state to implement negotiated health benefits and extend them to other employees, but only if doing so does not reduce or diminish existing benefits for employees not covered by the agreement. The measure takes effect immediately.

Impact

The bill would affect the Civil Service Law by expressly tying NYSHIP coverage to certain Insurance Law requirements and by codifying a reimbursement floor for out-of-network services. In practice, it would influence how state employee health plans calculate and pay claims, particularly for non-network providers, and would reinforce continuity of mandated health benefits. It also constrains the state’s ability to extend negotiated health benefits in a way that would reduce current benefits for other employees, thereby preserving existing coverage levels.

Sentiment

There is limited recorded discussion or voting history available for this bill, so overall sentiment cannot be measured from committee debate or floor votes. Based on the bill’s text and caption, the measure appears policy-focused and protective of existing health coverage, suggesting a generally favorable orientation toward maintaining benefits and clarifying reimbursement rules. No opposing testimony or recorded vote is provided in the available materials.

Contention

The main potential point of contention is the out-of-network reimbursement standard, which could affect costs for the state, employees, insurers, and providers by requiring payment at 80 percent of a benchmarked usual-and-customary rate. Another possible issue is the bill’s interaction with collective bargaining and benefit administration, since it preserves existing benefits and limits reductions when extending negotiated coverage to other employees. No specific stakeholders are identified in the available transcripts, but likely interested parties include state employee unions, the state budget and employee relations offices, insurers, and out-of-network providers.