Senate Bill S1038

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  1038

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                            January 22, 2009
                               ___________

Introduced  by Sens. LARKIN, FLANAGAN, LAVALLE -- read twice and ordered
  printed, and when printed to be committed to the Committee  on  Insur-
  ance

AN  ACT to amend the insurance law, in relation to the coverage of inpa-
  tient hospital care and anesthesia services related to  the  provision
  of dental services

  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 26 to read as follows:
  (26)(A)  EVERY  POLICY  WHICH PROVIDES COVERAGE FOR INPATIENT HOSPITAL
CARE SHALL NOT EXCLUDE COVERAGE FOR  INPATIENT  HOSPITAL  CARE  FOR  THE
PROVISION  OF  DENTAL SERVICES WHEN SUCH HOSPITAL CARE IS:  (I) PROVIDED
TO A COVERED PERSON WHO IS SEVERELY DISABLED OR IS UNDER FIVE  YEARS  OF
AGE;  AND  (II)  DETERMINED  TO  BE MEDICALLY NECESSARY BY THE ATTENDING
PHYSICIAN, IN CONSULTATION WITH A LICENSED DENTIST,  DUE  TO  A  MEDICAL
CONDITION  THAT  REQUIRES  HOSPITALIZATION OF THE COVERED PERSON FOR THE
PROVISION OF DENTAL SERVICES.
  (B) EVERY POLICY WHICH PROVIDES COVERAGE FOR SURGICAL CARE  SHALL  NOT
EXCLUDE  COVERAGE  FOR  ANESTHESIA  SERVICES  PROVIDED BY A PHYSICIAN OR
DENTIST WHEN SUCH ANESTHESIA SERVICES ARE: (I)  PROVIDED  TO  A  COVERED
PERSON  WHO  IS  SEVERELY  DISABLED  OR IS UNDER FIVE YEARS OF AGE; (II)
PROVIDED FOR THE PROVISION OF DENTAL SERVICES; AND (III)  DETERMINED  TO
BE  MEDICALLY NECESSARY BY THE ATTENDING PHYSICIAN, IN CONSULTATION WITH
A LICENSED DENTIST, DUE TO A MEDICAL  CONDITION  THAT  REQUIRES  GENERAL
ANESTHESIA FOR THE PROVISION OF DENTAL SERVICES.
  (C)  COVERAGE  PROVIDED PURSUANT TO THIS PARAGRAPH SHALL BE SUBJECT TO
ALL OTHER TERMS AND CONDITIONS OF COVERAGE, INCLUDING, BUT  NOT  LIMITED
TO  REQUIREMENTS  FOR PRIOR AUTHORIZATION OF SERVICES AND ANNUAL DEDUCT-
IBLES AND COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT
AND AS ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A
GIVEN POLICY.
  S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 15 to read as follows:

              

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06563-01-9

S. 1038                             2

  (15)(A) EVERY GROUP POLICY ISSUED OR DELIVERED  IN  THIS  STATE  WHICH
PROVIDES COVERAGE FOR INPATIENT HOSPITAL CARE SHALL NOT EXCLUDE COVERAGE
FOR  INPATIENT  HOSPITAL  CARE FOR THE PROVISION OF DENTAL SERVICES WHEN
SUCH HOSPITAL CARE IS: (I) PROVIDED TO A COVERED PERSON WHO IS  SEVERELY
DISABLED  OR  IS  UNDER  FIVE  YEARS  OF  AGE; AND (II) DETERMINED TO BE
MEDICALLY NECESSARY BY THE ATTENDING PHYSICIAN, IN CONSULTATION  WITH  A
LICENSED  DENTIST, DUE TO A MEDICAL CONDITION THAT REQUIRES HOSPITALIZA-
TION OF THE COVERED PERSON FOR THE PROVISION OF DENTAL SERVICES.
  (B) EVERY GROUP  POLICY  ISSUED  OR  DELIVERED  IN  THIS  STATE  WHICH
PROVIDES COVERAGE FOR SURGICAL CARE SHALL NOT EXCLUDE COVERAGE FOR ANES-
THESIA  SERVICES PROVIDED BY A PHYSICIAN OR DENTIST WHEN SUCH ANESTHESIA
SERVICES ARE: (I) PROVIDED TO A COVERED PERSON WHO IS SEVERELY  DISABLED
OR IS UNDER FIVE YEARS OF AGE; (II) PROVIDED FOR THE PROVISION OF DENTAL
SERVICES;  AND (III) DETERMINED TO BE MEDICALLY NECESSARY BY THE ATTEND-
ING PHYSICIAN, IN CONSULTATION WITH A LICENSED DENTIST, DUE TO A MEDICAL
CONDITION THAT REQUIRES GENERAL ANESTHESIA FOR THE PROVISION  OF  DENTAL
SERVICES.
  (C)  COVERAGE  PROVIDED PURSUANT TO THIS PARAGRAPH SHALL BE SUBJECT TO
ALL OTHER TERMS AND CONDITIONS OF COVERAGE, INCLUDING, BUT  NOT  LIMITED
TO  REQUIREMENTS  FOR  PRIOR AUTHORIZATION OF SERVICES OR ANNUAL DEDUCT-
IBLES AND COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT
AND AS ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A
GIVEN POLICY.
  S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (ff) to read as follows:
  (FF)  (1)  EVERY  CONTRACT ISSUED BY A HOSPITAL SERVICE CORPORATION OR
HEALTH SERVICE CORPORATION WHICH PROVIDES COVERAGE FOR INPATIENT  HOSPI-
TAL CARE SHALL NOT EXCLUDE  COVERAGE FOR INPATIENT HOSPITAL CARE FOR THE
PROVISION  OF  DENTAL SERVICES WHEN SUCH HOSPITAL CARE IS:  (A) PROVIDED
TO A COVERED PERSON WHO IS SEVERELY DISABLED OR IS UNDER FIVE  YEARS  OF
AGE;  AND  (B)  DETERMINED  TO  BE  MEDICALLY NECESSARY BY THE ATTENDING
PHYSICIAN, IN CONSULTATION WITH A LICENSED DENTIST,  DUE  TO  A  MEDICAL
CONDITION  THAT  REQUIRES  HOSPITALIZATION OF THE COVERED PERSON FOR THE
PROVISION OF DENTAL SERVICES.
  (2) EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE  INDEMNITY  CORPORATION
OR  A  HEALTH  SERVICE  CORPORATION WHICH PROVIDES COVERAGE FOR SURGICAL
CARE SHALL NOT EXCLUDE COVERAGE FOR ANESTHESIA SERVICES  PROVIDED  BY  A
PHYSICIAN  OR DENTIST WHEN SUCH ANESTHESIA SERVICES ARE: (A) PROVIDED TO
A COVERED PERSON WHO IS SEVERELY DISABLED OR IS UNDER FIVE YEARS OF AGE;
(B) PROVIDED FOR THE PROVISION OF DENTAL SERVICES; AND (C) DETERMINED TO
BE MEDICALLY NECESSARY BY THE ATTENDING PHYSICIAN, IN CONSULTATION  WITH
A  LICENSED  DENTIST,  DUE  TO A MEDICAL CONDITION THAT REQUIRES GENERAL
ANESTHESIA FOR THE PROVISION OF DENTAL SERVICES.
  (3) COVERAGE PROVIDED PURSUANT TO THIS SUBSECTION SHALL BE SUBJECT  TO
ALL  OTHER  TERMS AND CONDITIONS OF COVERAGE, INCLUDING, BUT NOT LIMITED
TO REQUIREMENTS FOR PRIOR AUTHORIZATION OF SERVICES  OR  ANNUAL  DEDUCT-
IBLES AND COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT
AND AS ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A
GIVEN POLICY.
  S  4. This act shall take effect on the first of January next succeed-
ing the date on which it shall have become a law and shall apply to  all
policies  and contracts issued, renewed, modified, altered or amended on
or after such date.