S T A T E O F N E W Y O R K
________________________________________________________________________
S. 1186 A. 3486
2009-2010 Regular Sessions
S E N A T E - A S S E M B L Y
January 27, 2009
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IN SENATE -- Introduced by Sen. LAVALLE -- read twice and ordered print-
ed, and when printed to be committed to the Committee on Insurance
IN ASSEMBLY -- Introduced by M. of A. THIELE -- read once and referred
to the Committee on Insurance
AN ACT to amend the insurance law, in relation to health insurance bene-
fits for dependent children
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 4 of subsection (a) of section 3216 of the insur-
ance law, as amended by section 65-d of part A of chapter 58 of the laws
of 2007, is amended to read as follows:
(4) "Dependent children" (A) shall include any [children under a spec-
ified age which shall not exceed age nineteen] UNMARRIED DEPENDENT CHILD
UP TO AT LEAST TWENTY-FIVE YEARS OF AGE WHO IS NOT ELIGIBLE FOR COVERAGE
UNDER A POLICY OF ACCIDENT AND HEALTH INSURANCE OFFERED THROUGH HIS OR
HER EMPLOYER except:
[(i)] Any unmarried dependent child, regardless of age, who is incapa-
ble of self-sustaining employment by reason of mental illness, develop-
mental disability, or mental retardation as defined in the mental
hygiene law, or physical handicap and who became so incapable prior to
the age at which dependent coverage would otherwise terminate, shall be
included in coverage subject to any pre-existing conditions limitation
applicable to other dependents.
[(ii) Any unmarried student at an accredited institution of learning
may be considered a dependent child until attaining age twenty-three.]
(B) may include, at the option of the insurer, any unmarried child
until attaining age twenty-five.
S 2. Paragraph 1 of subsection (d) of section 4304 of the insurance
law, as amended by section 65-e of part A of chapter 58 of the laws of
2007, is amended to read as follows:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05594-01-9
S. 1186 2 A. 3486
(1) No contract issued pursuant to this section shall entitle more
than one person to benefits except that a contract issued and marked as
a "family contract" [may] SHALL provide that benefits will be furnished
to a husband and wife, or husband, wife and their dependent child or
children, or any UNMARRIED child or children [not over nineteen] UP TO
AT LEAST TWENTY-FIVE years of age, [provided that an unmarried student
at an accredited institution of learning may be considered a dependent
until he becomes twenty-three years of age,] WHO IS NOT ELIGIBLE FOR
COVERAGE UNDER A POLICY OF ACCIDENT AND HEALTH INSURANCE OFFERED THROUGH
HIS OR HER EMPLOYER, provided that the coverage of any such "family
contract" may include, at the option of the insurer, any unmarried child
until attaining age twenty-five, and provided also that the coverage of
any such "family contract" shall include any other unmarried child,
regardless of age, who is incapable of self-sustaining employment by
reason of mental illness, developmental disability, mental retardation,
as defined in the mental hygiene law, or physical handicap and who
became so incapable prior to attainment of the age at which dependent
coverage would otherwise terminate, so that such child may be considered
a dependent. Notwithstanding any rule, regulation or law to the contra-
ry, any "family contract" shall provide that coverage of newborn
infants, including newly born infants adopted by the insured or
subscriber if such insured or subscriber takes physical custody of the
infant upon such infant's release from the hospital and files a petition
pursuant to section one hundred fifteen-c of the domestic relations law
within thirty days of birth; and provided further that no notice of
revocation to the adoption has been filed pursuant to section one
hundred fifteen-b of the domestic relations law and consent to the
adoption has not been revoked, shall be effective from the moment of
birth for injury or sickness including the necessary care and treatment
of medically diagnosed congenital defects and birth abnormalities
including premature birth, except that in cases of adoption, coverage of
the initial hospital stay shall not be required where a birth parent has
insurance coverage available for the infant's care. This provision
regarding coverage of newborn infants shall not apply to two person
coverage. In the case of individual or two person coverages the corpo-
ration must also permit the person to whom the policy is issued to elect
such coverage of newborn infants from the moment of birth. If notifica-
tion and/or payment of an additional premium or contribution is required
to make coverage effective for a newborn infant, the coverage may
provide that such notice and/or payment be made within no less than
thirty days of the day of birth to make coverage effective from the
moment of birth. This election shall not be required in the case of
student insurance or where the group remitting agent's plan does not
provide coverage for dependent children.
S 3. Paragraph 1 of subsection (c) of section 4305 of the insurance
law, as amended by chapter 312 of the laws of 2002, is amended to read
as follows:
(1) Any such contract may provide that benefits will be furnished to a
member of a covered group, for himself, his spouse, his child or chil-
dren, or other persons chiefly dependent upon him for support and main-
tenance; provided that a contract under which coverage of a dependent of
a member terminates at a specified age, WHICH SHALL NOT BE LESS THAN
TWENTY-FIVE YEARS FOR AN UNMARRIED DEPENDENT CHILD WHO IS NOT ELIGIBLE
FOR COVERAGE BY A POLICY OF ACCIDENT AND HEALTH INSURANCE OFFERED BY HIS
OR HER EMPLOYER, shall, with respect to an unmarried child who is inca-
pable of self-sustaining employment by reason of mental illness, devel-
S. 1186 3 A. 3486
opmental disability, mental retardation, as defined in the mental
hygiene law, or physical handicap and who became so incapable prior to
attainment of the age at which dependent coverage would otherwise termi-
nate and who is chiefly dependent upon such member for support and main-
tenance, not so terminate while the contract remains in force and the
dependent remains in such condition, if the member has within thirty-one
days of such dependent's attainment of the termination age submitted
proof of such dependent's incapacity as described herein. Notwithstand-
ing any rule, regulation or law to the contrary, any contract under
which a member elects coverage for himself, his spouse, his children or
other persons chiefly dependent upon him for support and maintenance
shall provide that coverage of newborn infants, including newly born
infants adopted by the insured or subscriber if such insured or
subscriber takes physical custody of the infant upon such infant's
release from the hospital and files a petition pursuant to section one
hundred fifteen-c of the domestic relations law within thirty days of
birth; and provided further that no notice of revocation to the adoption
has been filed pursuant to section one hundred fifteen-b of the domestic
relations law and consent to the adoption has not been revoked, shall be
effective from the moment of birth for injury or sickness including the
necessary care and treatment of medically diagnosed congenital defects
and birth abnormalities including premature birth, except that in cases
of adoption, coverage of the initial hospital stay shall not be required
where a birth parent has insurance coverage available for the infant's
care. This provision regarding coverage of newborn infants shall not
apply to two person coverage. In the case of individual or two person
coverages the corporation must also permit the person to whom the
certificate is issued to elect such coverage of newborn infants from the
moment of birth. If notification and/or payment of an additional premium
or contribution is required to make coverage effective for a newborn
infant, the coverage may provide that such notice and/or payment be made
within no less than thirty days of the day of birth to make coverage
effective from the moment of birth. This election shall not be required
in the case of student insurance or where the group's plan does not
provide coverage for dependent children.
S 4. This act shall take effect immediately and shall apply to poli-
cies issued, renewed, modified or amended on and after such date.