Senate Bill S3028

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

                                  3028

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                              March 9, 2009
                               ___________

Introduced  by  Sens.  LAVALLE,  DIAZ,  HANNON, LARKIN, MORAHAN, PARKER,
  SKELOS -- read twice and ordered  printed,  and  when  printed  to  be
  committed to the Committee on Insurance

AN  ACT  to  amend  the  insurance  law, in relation to health insurance
  coverage for maternity care expenses incurred by adoptive parents

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Paragraph  10  of  subsection  (i) of section 3216 of the
insurance law is amended by adding a new subparagraph  (C)  to  read  as
follows:
  (C) EVERY POLICY WHICH PROVIDES MAJOR MEDICAL OR SIMILAR COMPREHENSIVE
TYPE  COVERAGE  SHALL  PROVIDE  FOR  THE REIMBURSEMENT OF A POLICYHOLDER
LEGALLY ADOPTING A NEWBORN CHILD FOR THE COST OF PRENATAL CARE, MATERNI-
TY CARE, AND PRIMARY AND PREVENTIVE CARE RENDERED ON BEHALF OF THE BIRTH
MOTHER OR CHILD PURSUANT TO THIS PARAGRAPH AND  PARAGRAPH  SEVENTEEN  OF
THIS  SUBSECTION,  TO THE SAME EXTENT THAT HOSPITAL, SURGICAL OR MEDICAL
COVERAGE IS PROVIDED FOR ILLNESS OR DISEASE UNDER THE POLICY, SO LONG AS
THE FOLLOWING CONDITIONS ARE MET:
  (I) THE BIOLOGICAL MOTHER IS UNINSURED AT THE TIME OF  THE  BIRTH  AND
GIVES  BIRTH  IN  THE  UNITED  STATES  AND  PAYMENT HAS BEEN MADE TO THE
PROVIDER OR PROVIDERS OF SERVICES BY OR ON BEHALF OF THE POLICYHOLDER;
  (II) A SWORN STATEMENT IS SUBMITTED BY THE BIOLOGICAL MOTHER THAT  SHE
DOES  NOT  HAVE  PUBLIC OR PRIVATE INSURANCE COVERAGE FOR PRENATAL CARE,
MATERNITY CARE AND PRIMARY AND PREVENTIVE CARE DURING THE PERIOD OF  THE
PREGNANCY AND BIRTH;
  (III)  THE CHILD IS PLACED FOR ADOPTION WITHIN SIX MONTHS OF THE BIRTH
AND THE POLICYHOLDER NOTIFIES THE INSURER  IN  WRITING  OF  THE  CERTIF-
ICATION  OF  THE  ADOPTER  OR  ADOPTERS  PURSUANT TO SECTION ONE HUNDRED
FIFTEEN-D OF THE DOMESTIC RELATIONS LAW, WAIVER OF THE CERTIFICATION  OR
OF THE APPROVAL TO ADOPT BY AN AUTHORIZED AGENCY;

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD08969-01-9

              

S. 3028                             2

  (IV)  THE  POLICYHOLDER  FILES  WITH  THE  INSURER  PRIOR  TO  SEEKING
REIMBURSEMENT  DOCUMENTATION  INDICATING  THE  DATE  THAT  THE  ADOPTION
PROCEEDING  WAS  COMMENCED  AND  THE  COURT  IN  WHICH IT WAS COMMENCED,
TOGETHER WITH THE FILE OR DOCKET NUMBER ASSIGNED TO THE PROCEEDING; AND
  (V)  THE  POLICYHOLDER  SUBMITS  WRITTEN  DOCUMENTATION OF ALL MEDICAL
EXPENSES INCURRED WITH RESPECT TO THE BIOLOGICAL MOTHER  AND  THE  CHILD
PRIOR TO, AT THE TIME OF, AND FOLLOWING THE BIRTH.
  FOR  THE  PURPOSES  OF THIS SUBPARAGRAPH, REIMBURSEMENT SHALL BE IN AN
AMOUNT EQUAL TO EITHER THE AMOUNT THAT WOULD HAVE BEEN PAID HAD SERVICES
BEEN PROVIDED WITHIN AN INSURER'S NETWORK OF PARTICIPATING PROVIDERS, OR
IN THE CASE OF AN INSURER WHICH PERMITS SUBSCRIBERS TO RECEIVE  SERVICES
OUTSIDE  OF  A NETWORK OF PARTICIPATING PROVIDERS THE USUAL OR CUSTOMARY
COST OF PRENATAL CARE, MATERNITY CARE AND PRIMARY AND PREVENTATIVE  CARE
COVERED  UNDER THE POLICY, SUBJECT IN BOTH CASES TO ANY APPLICABLE LIMI-
TATIONS, DEDUCTIBLES AND COINSURANCE, LESS THE PREMIUM,  IF  ANY,  WHICH
WOULD HAVE BEEN REQUIRED HAD THE CHILD BEEN ADDED TO THE POLICY PURSUANT
TO SUBPARAGRAPH (C) OF PARAGRAPH FOUR OF SUBSECTION (C) OF THIS SECTION.
  S  2.  Paragraph  5 of subsection (k) of section 3221 of the insurance
law is amended by adding a new subparagraph (C) to read as follows:
  (C) EVERY GROUP OR BLANKET ACCIDENT AND HEALTH INSURANCE POLICY ISSUED
OR ISSUED FOR DELIVERY IN THIS STATE WHICH  PROVIDES  MAJOR  MEDICAL  OR
SIMILAR  COMPREHENSIVE TYPE COVERAGE SHALL PROVIDE FOR THE REIMBURSEMENT
OF A POLICYHOLDER LEGALLY ADOPTING A  NEWBORN  CHILD  FOR  THE  COST  OF
PRENATAL  CARE, MATERNITY CARE, AND PRIMARY AND PREVENTIVE CARE RENDERED
ON BEHALF OF THE BIRTH MOTHER OR CHILD PURSUANT TO  THIS  PARAGRAPH  AND
PARAGRAPH  EIGHT  OF  SUBSECTION (L) OF THIS SECTION, TO THE SAME EXTENT
THAT HOSPITAL, SURGICAL OR MEDICAL COVERAGE IS PROVIDED FOR  ILLNESS  OR
DISEASE UNDER THE POLICY, SO LONG AS THE FOLLOWING CONDITIONS ARE MET:
  (I)  THE  BIOLOGICAL  MOTHER IS UNINSURED AT THE TIME OF THE BIRTH AND
GIVES BIRTH IN THE UNITED STATES  AND  PAYMENT  HAS  BEEN  MADE  TO  THE
PROVIDER OR PROVIDERS OF SERVICES BY OR ON BEHALF OF THE POLICYHOLDER;
  (II)  A SWORN STATEMENT IS SUBMITTED BY THE BIOLOGICAL MOTHER THAT SHE
DOES NOT HAVE PUBLIC OR PRIVATE INSURANCE COVERAGE  FOR  PRENATAL  CARE,
MATERNITY  CARE AND PRIMARY AND PREVENTIVE CARE DURING THE PERIOD OF THE
PREGNANCY AND BIRTH;
  (III) THE CHILD IS PLACED FOR ADOPTION WITHIN SIX MONTHS OF THE  BIRTH
AND  THE  POLICYHOLDER  NOTIFIES  THE  INSURER IN WRITING OF THE CERTIF-
ICATION OF THE ADOPTER OR  ADOPTERS  PURSUANT  TO  SECTION  ONE  HUNDRED
FIFTEEN-D  OF THE DOMESTIC RELATIONS LAW, WAIVER OF THE CERTIFICATION OR
OF THE APPROVAL TO ADOPT BY AN AUTHORIZED AGENCY;
  (IV)  THE  POLICYHOLDER  FILES  WITH  THE  INSURER  PRIOR  TO  SEEKING
REIMBURSEMENT  DOCUMENTATION  INDICATING  THE  DATE  THAT  THE  ADOPTION
PROCEEDING WAS COMMENCED AND  THE  COURT  IN  WHICH  IT  WAS  COMMENCED,
TOGETHER WITH THE FILE OR DOCKET NUMBER ASSIGNED TO THE PROCEEDING; AND
  (V)  THE  POLICYHOLDER  SUBMITS  WRITTEN  DOCUMENTATION OF ALL MEDICAL
EXPENSES INCURRED WITH RESPECT TO THE BIOLOGICAL MOTHER  AND  THE  CHILD
PRIOR TO, AT THE TIME OF, AND FOLLOWING THE BIRTH.
  FOR  THE  PURPOSES  OF THIS SUBPARAGRAPH, REIMBURSEMENT SHALL BE IN AN
AMOUNT EQUAL TO EITHER THE AMOUNT THAT WOULD HAVE BEEN PAID HAD SERVICES
BEEN PROVIDED WITHIN AN INSURER'S NETWORK OF PARTICIPATING PROVIDERS, OR
IN THE CASE OF AN INSURER WHICH PERMITS SUBSCRIBERS TO RECEIVE  SERVICES
OUTSIDE  OF  A NETWORK OF PARTICIPATING PROVIDERS THE USUAL OR CUSTOMARY
COST OF PRENATAL CARE, MATERNITY CARE AND PRIMARY AND PREVENTATIVE  CARE
COVERED  UNDER THE POLICY, SUBJECT IN BOTH CASES TO ANY APPLICABLE LIMI-
TATIONS, DEDUCTIBLES AND COINSURANCE, LESS THE PREMIUM,  IF  ANY,  WHICH

S. 3028                             3

WOULD HAVE BEEN REQUIRED HAD THE CHILD BEEN ADDED TO THE POLICY PURSUANT
TO THIS SECTION.
  S 3. Subsection (c) of section 4303 of the insurance law is amended by
adding a new paragraph 3 to read as follows:
  (3)  EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION,
HOSPITAL  SERVICE  CORPORATION  OR  HEALTH  SERVICE  CORPORATION   WHICH
PROVIDES  MAJOR  MEDICAL  OR  SIMILAR  COMPREHENSIVE TYPE COVERAGE SHALL
PROVIDE FOR THE REIMBURSEMENT  OF  A  POLICYHOLDER  LEGALLY  ADOPTING  A
NEWBORN CHILD FOR PRENATAL CARE, MATERNITY CARE, AND PRIMARY AND PREVEN-
TIVE  CARE  RENDERED  ON BEHALF OF THE BIRTH MOTHER OR CHILD PURSUANT TO
THIS SUBSECTION AND SUBSECTION (J) OF THIS SECTION, TO THE  SAME  EXTENT
THAT  HOSPITAL,  SURGICAL OR MEDICAL COVERAGE IS PROVIDED FOR ILLNESS OR
DISEASE UNDER THE POLICY, SO LONG AS THE FOLLOWING CONDITIONS ARE MET:
  (I) THE BIOLOGICAL MOTHER IS UNINSURED AT THE TIME OF  THE  BIRTH  AND
GIVES  BIRTH  IN  THE  UNITED  STATES  AND  PAYMENT HAS BEEN MADE TO THE
PROVIDER OR PROVIDERS OF SERVICES BY OR ON BEHALF OF THE POLICYHOLDER;
  (II) A SWORN STATEMENT IS SUBMITTED BY THE BIOLOGICAL MOTHER THAT  SHE
DOES  NOT  HAVE  PUBLIC OR PRIVATE INSURANCE COVERAGE FOR PRENATAL CARE,
MATERNITY CARE AND PRIMARY AND PREVENTIVE CARE DURING THE PERIOD OF  THE
PREGNANCY AND BIRTH;
  (III)  THE CHILD IS PLACED FOR ADOPTION WITHIN SIX MONTHS OF THE BIRTH
AND THE POLICYHOLDER NOTIFIES THE INSURER  IN  WRITING  OF  THE  CERTIF-
ICATION  OF  THE  ADOPTER  OR  ADOPTERS  PURSUANT TO SECTION ONE HUNDRED
FIFTEEN-D OF THE DOMESTIC RELATIONS LAW, WAIVER OF THE CERTIFICATION  OR
OF THE APPROVAL TO ADOPT BY AN AUTHORIZED AGENCY;
  (IV)  THE  POLICYHOLDER  FILES  WITH  THE CORPORATION PRIOR TO SEEKING
REIMBURSEMENT  DOCUMENTATION  INDICATING  THE  DATE  THAT  THE  ADOPTION
PROCEEDING  WAS  COMMENCED  AND  THE  COURT  IN  WHICH IT WAS COMMENCED,
TOGETHER WITH THE FILE OR DOCKET NUMBER ASSIGNED TO THE PROCEEDING; AND
  (V) THE POLICYHOLDER SUBMITS  WRITTEN  DOCUMENTATION  OF  ALL  MEDICAL
EXPENSES  INCURRED  WITH  RESPECT TO THE BIOLOGICAL MOTHER AND THE CHILD
PRIOR TO, AT THE TIME OF, AND FOLLOWING THE BIRTH.
  FOR THE PURPOSES OF THIS  PARAGRAPH,  REIMBURSEMENT  SHALL  BE  IN  AN
AMOUNT EQUAL TO EITHER THE AMOUNT THAT WOULD HAVE BEEN PAID HAD SERVICES
BEEN PROVIDED WITHIN A CORPORATION'S NETWORK OF PARTICIPATING PROVIDERS,
OR  IN  THE  CASE  OF A CORPORATION WHICH PERMITS SUBSCRIBERS TO RECEIVE
SERVICES OUTSIDE OF A NETWORK OF PARTICIPATING PROVIDERS  THE  USUAL  OR
CUSTOMARY  COST OF PRENATAL CARE, MATERNITY CARE AND PRIMARY AND PREVEN-
TATIVE CARE COVERED UNDER THE POLICY,  SUBJECT  IN  BOTH  CASES  TO  ANY
APPLICABLE  LIMITATIONS,  DEDUCTIBLES AND COINSURANCE, LESS THE PREMIUM,
IF ANY, WHICH WOULD HAVE BEEN REQUIRED HAD THE CHILD BEEN ADDED  TO  THE
POLICY PURSUANT TO PARAGRAPH ONE OF SUBSECTION (D) OF SECTION FOUR THOU-
SAND  THREE  HUNDRED  FOUR OR PARAGRAPH ONE OF SUBSECTION (C) OF SECTION
FOUR THOUSAND THREE HUNDRED FIVE OF THIS ARTICLE.
  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.