4306-C - Grievance procedure and access to specialty care.
* § 4306-c. Grievance procedure and access to specialty care. (a) A corporation, including a municipal cooperative health benefits plan certified pursuant to article forty-seven of this chapter, that issues a comprehensive contract that utilizes a network of providers and is not a managed care health insurance contract as defined in subsection (c) of section four thousand eight hundred one of this chapter shall establish and maintain a grievance procedure consistent with the requirements of section four thousand eight hundred two of this chapter. (b) A corporation, including a municipal cooperative health benefits plan certified pursuant to article forty-seven of this chapter, that issues a comprehensive contract that utilizes a network of providers and is not a managed care health insurance contract as defined in subsection (c) of section four thousand eight hundred one of this chapter and requires that specialty care be provided pursuant to a referral from a primary care provider shall provide access to such specialty care consistent with the requirements of subsections (b), (c) and (d) of section four thousand eight hundred four of this chapter; provided however, that nothing in this section shall be construed to require that a corporation, or a primary care provider on behalf of the corporation, make a referral to a provider that is not in the corporation's network. (c) A corporation, including a municipal cooperative health benefits plan certified pursuant to article forty-seven of this chapter, that issues a comprehensive contract that utilizes a network of providers and is not a managed care health insurance contract as defined in subsection (c) of section four thousand eight hundred one of this chapter shall provide access to transitional care consistent with the requirements of subsections (e) and (f) of section four thousand eight hundred four of this chapter. * NB Effective January 1, 2011