BILL NUMBER:A10231
TITLE OF BILL: An act to amend the insurance law, in relation to annual
physicals and well care visits
PURPOSE: This legislation would provide that insurance policies that
cover annual physicals and well care visits shall allow one visit per
calendar year.
SUMMARY OF PROVISIONS: Sections 3216, 3221 and 4303 of the New York
State Insurance Law are amended to add new paragraphs to provide that
insurance policies that cover annual physicals and well care visits
shall allow one visit per calendar year regardless if 365 days has
passed since the previous physical or well care visit.
JUSTIFICATION: Most health care insurers in New York State allow one
well-care visit or physical per year. To the insurance company that
means one such visit every 365 day period. While on the surface this
seems appropriate, it actually presents a unfair deterrent to care.
If an individual has a physical on August 28, 2009, that individual must
wait until at least that date next year for their next covered physical
or wellness visit. This creates a problem. For example, if a student
needs a school required physical before the 365 day period has expired,
that student may be delayed in participating in certain school activ-
ities or functions.
S T A T E O F N E W Y O R K
________________________________________________________________________
10231
I N A S S E M B L Y
March 11, 2010
___________
Introduced by M. of A. GUNTHER, GOTTFRIED -- read once and referred to
the Committee on Insurance
AN ACT to amend the insurance law, in relation to annual physicals and
well care visits
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subsection (i) of section 3216 of the insurance law is
amended by adding a new paragraph 27 to read as follows:
(27) EVERY INDIVIDUAL POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL OR
SIMILAR COMPREHENSIVE-TYPE COVERAGE THAT INCLUDES COVERAGE FOR A PHYS-
ICAL OR WELL CARE VISIT ONCE IN EVERY THREE HUNDRED SIXTY-FIVE DAYS
SHALL BE INTERPRETED TO MEAN THAT SUCH PHYSICAL OR WELL CARE VISIT CAN
BE HAD ONCE EVERY CALENDAR YEAR, REGARDLESS OF WHETHER OR NOT A PERIOD
OF THREE HUNDRED SIXTY-FIVE DAYS HAS PASSED SINCE THE PREVIOUS PHYSICAL
OR WELL CARE VISIT.
S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 16 to read as follows:
(16) EVERY GROUP OR BLANKET POLICY WHICH PROVIDES MEDICAL, MAJOR
MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE THAT INCLUDES COVERAGE
FOR A PHYSICAL OR WELL CARE VISIT ONCE IN EVERY THREE HUNDRED SIXTY-FIVE
DAYS SHALL BE INTERPRETED TO MEAN THAT SUCH PHYSICAL OR WELL CARE VISIT
CAN BE HAD ONCE EVERY CALENDAR YEAR, REGARDLESS OF WHETHER OR NOT A
PERIOD OF THREE HUNDRED SIXTY-FIVE DAYS HAS PASSED SINCE THE PREVIOUS
PHYSICAL OR WELL CARE VISIT.
S 3. Section 4303 of the insurance law is amended by adding a new
subsection (gg) to read as follows:
(GG) EVERY CONTRACT ISSUED BY A CORPORATION SUBJECT TO THE PROVISIONS
OF THIS ARTICLE WHICH PROVIDES MEDICAL, MAJOR MEDICAL OR SIMILAR COMPRE-
HENSIVE-TYPE COVERAGE THAT INCLUDES COVERAGE FOR A PHYSICAL OR WELL CARE
VISIT ONCE IN EVERY THREE HUNDRED SIXTY-FIVE DAYS SHALL BE INTERPRETED
TO MEAN THAT SUCH PHYSICAL OR WELL CARE VISIT CAN BE HAD ONCE EVERY
CALENDAR YEAR, REGARDLESS OF WHETHER OR NOT A PERIOD OF THREE HUNDRED
SIXTY-FIVE DAYS HAS PASSED SINCE THE PREVIOUS PHYSICAL OR WELL CARE
VISIT.
S 4. This act shall take effect on the ninetieth day after it shall
have become a law and shall apply to policies and contracts issued,
renewed, modified, altered or amended on or after such date.
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