New York Additional Disclosure of Information for individuals looking for New York Coverage
In accordance with NY Ins. Law s. 3217-a(b), upon request Aflac will:
- Provide a list of the names, business addresses and official positions of the membership of the board of directors, officers, and members of the insurer; Provide a copy of the most recent annual certified financial statement of the insurer, including a balance sheet and summary of receipts and disbursements prepared by a certified public accountant.
- Provide information relating to consumer complaints.
- Provide the procedures for protecting the confidentiality of medical records and other insured information.
- Provide a written description of the organizational arrangements and ongoing procedures of Aflac’s assurance program.
- Provide a description of Aflac’s procedures for making decisions about the experimental or investigational nature of individual drugs, medical devices or treatments in clinical trials.
- Provide, upon written request by an insured, prospective insured, or health care professional acting on an insured’s behalf, specific written clinical review criteria relating to a particular condition or disease including clinical review criteria relating to a step therapy protocol override determination and, where appropriate, other clinical information which Aflac might consider in its utilization review. This information may only be used for the purposes of assisting the enrollee or prospective enrollee in evaluating the covered services provided by the organization.
- Provide the written application procedures and minimum qualification requirements for health care providers Aflac considers for participation in the insurer's network [only applicable to a managed care product].
- Disclose such other information as required by the superintendent pursuant to the state administrative procedure act.
- Disclose whether a health care provider scheduled to provide a health care service is an in-network provider.
- With respect to out-of-network coverage, disclose the approximate dollar amount that the insurer will pay for a specific out-of-network health care service, including that such approximation is not binding on the insurer and that the approximate dollar amount that the insurer will pay for a specific out-of-network health care service may change.
- Please access our Dental and Vision Provider Directories online at Health Care Providers Information
- For an out-of-network estimate of costs you can estimate the amount by asking your provider directly or going to Fair Health. Choose dental link, put in your zip code and procedure. Aflac uses the 90th percentile which you can customize in the tool.
- If you need help in another language or a document in another format, please call us toll-free at 855-819-1873.
- Aflac offers two Dental plan network options: Preferred Provider Option (PPO) or Maximum Allowable Charges (MAC). Each plan offers distinct advantages that caters to the unique needs of our members. Our PPO plan have dentists who are in our plan’s network. These providers have agreed to a pre-negotiated fee schedule, ensuring lower costs for covered procedures. Our PPO plan provides a broad network of dentists and cover 90th of the Usual, Reasonable and Customary (UCR) charges for out-of-network services, offering our members greater flexibility in choosing providers. Our MAC plan operates similarly to our PPO plan for in-network services but differ sign significantly in out-of-network reimbursements. This main difference caps payment for services provided by an out-of-network dentist at the designed maximum allowable charge (MAC) usually at the 30th UCR.
- For our Vision plans, we reimburse our providers based on whether they are participants in a pre-determined network. Members covered under our vision plans will either have a benefit allowance to use or a co-pay to satisfy. An out-of-network claim is paid in full by the member at the point of sale, and a claim form is submitted for reimbursement. Typically shown as some percentage of the in-network benefit and varies by service. The out-of-network reimbursement will never be more than the network benefit. Several states mandate certain thresholds, such as “out-of-network coverage cannot be less than 80% of the network benefit”. There are also states which mandate that if there is coverage in-network for a covered service, there must also be some level of out-of-network coverage as well. Typically, out-of-network reimbursements vary from 40-80% of the network benefit, and there is flexibility in that amount unless it is one of the states which mandate certain coverage levels.
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