Senate Bill S1186

                            
                    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
                               ___________

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.