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

                                  1969

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                            January 12, 2011
                               ___________

Introduced by M. of A. JEFFRIES -- read once and referred to the Commit-
  tee 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, subparagraph (C) as added by chapter 240 of the laws  of  2009,
is amended to read as follows:
  (4) "Dependent  children"  [(A)]  shall  include any [children under a
specified age which shall not exceed age nineteen] DEPENDENT CHILD UP TO
AT LEAST TWENTY-FIVE YEARS OF AGE WHO IS NOT OTHERWISE COVERED  UNDER  A
POLICY  OF  ACCIDENT  AND  HEALTH  INSURANCE  OFFERED THROUGH HIS OR HER
EMPLOYER except[:
  (i) Any] ANY unmarried dependent child,  regardless  of  age,  who  is
incapable  of  self-sustaining  employment  by reason of mental illness,
developmental 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.
  (C)] In addition to the requirements of [subparagraphs (A) and (B) of]
this  paragraph, every insurer issuing a policy pursuant to this section
that provides coverage for dependent children must make  available  and,
if requested by the policyholder, extend coverage under the policy to an
unmarried  child  through  age  twenty-nine, without regard to financial

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05031-01-1
              

A. 1969                             2

dependence who is not insured by  or  eligible  for  coverage  under  an
employer  sponsored  health benefit plan covering them as an employee or
member, whether insured or self-insured, and who lives, works or resides
in  New  York  state  or  the service area of the insurer. Such coverage
shall be made available at the inception of all new policies and at  the
first  anniversary date of a policy following the effective date of this
subparagraph. Written notice of the availability of such coverage  shall
be  delivered  to the policyholder thirty days prior to the inception of
such group policy and thirty days prior to the  first  anniversary  date
following the effective date of this subparagraph.
  S 2. Subparagraph (A) of paragraph 1 of subsection (d) of section 4304
of  the insurance law, as amended by chapter 240 of the laws of 2009, is
amended to read as follows:
  (A) 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 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, 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,] WHO IS NOT OTHERWISE
COVERED UNDER A POLICY OF ACCIDENT AND HEALTH INSURANCE OFFERED  THROUGH
HIS  OR  HER  EMPLOYER  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  other-
wise terminate, so that such child may be considered a dependent.
  S 3. Subparagraph (A) of paragraph 1 of subsection (c) of section 4305
of  the insurance law, as amended by chapter 240 of the laws of 2009, is
amended to read as follows:
  (A) 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 A DEPENDENT CHILD WHO IS NOT OTHERWISE COVERED BY
A POLICY OF ACCIDENT AND HEALTH INSURANCE OFFERED BY HIS OR HER  EMPLOY-
ER,  shall, with respect to an unmarried child who is incapable of self-
sustaining employment by reason of mental illness,  developmental  disa-
bility,  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  and  who  is
chiefly  dependent  upon such member for support and maintenance, 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.
  S  4.  This act shall take effect immediately and shall apply to poli-
cies issued, renewed, modified or amended on and after such date.