S T A T E O F N E W Y O R K
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2945
2011-2012 Regular Sessions
I N A S S E M B L Y
January 21, 2011
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Introduced by M. of A. GLICK, JACOBS, DINOWITZ, WEINSTEIN, JAFFEE --
Multi-Sponsored by -- M. of A. CYMBROWITZ, GALEF, O'DONNELL, ORTIZ,
PAULIN, SCARBOROUGH -- read once and referred to the Committee on
Insurance
AN ACT to amend the insurance law, in relation to requiring that
provision be made for pregnancy termination procedures in every indi-
vidual or group policy or contract which provides coverage or indem-
nity for hospital, surgical or medical care and which offers maternity
care coverage
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 10-a to read as follows:
(10-A) (A) EVERY POLICY WHICH PROVIDES HOSPITAL, SURGICAL OR MEDICAL
COVERAGE AND WHICH OFFERS MATERNITY CARE COVERAGE PURSUANT TO PARAGRAPH
TEN OF THIS SUBSECTION SHALL ALSO PROVIDE COVERAGE FOR PREGNANCY TERMI-
NATION PROCEDURES WHICH ARE PERFORMED BY A LICENSED PHYSICIAN, UPON THE
POLICYHOLDER OR UPON HIS SPOUSE OR UPON A NONSPOUSE WHO IS DEPENDENT
UPON THE POLICYHOLDER, IN ANY LICENSED HOSPITAL OR MEDICAL FACILITY
APPROVED BY THE STATE COMMISSIONER OF HEALTH, TO THE SAME EXTENT THAT
COVERAGE IS PROVIDED FOR ILLNESS OR DISEASE UNDER THE POLICY, SUBJECT TO
THE PROVISIONS OF THIS PARAGRAPH.
(B) PROVISION FOR SUCH COVERAGE SHALL BE SUBJECT TO ANY GUIDELINES
WHICH ARE NOW OR HEREAFTER ISSUED BY THE MEDICAL SPECIALTY SOCIETIES
RECOGNIZED BY THE AMERICAN BOARD OF MEDICAL SPECIALTIES OF OBSTETRICS
AND GYNECOLOGY, FOR PREGNANCY TERMINATIONS AND ABORTIONS.
(C) SUCH COVERAGE SHALL BE PROVIDED IN A MANNER WHICH ENSURES THE
CONFIDENTIALITY AND PRIVACY OF THE OCCURRENCE OF THE PROCEDURES
PERFORMED TO THE PERSON FOR WHOM COVERAGE IS PROVIDED.
(D) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE
AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05938-01-1
A. 2945 2
WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY, BUT
SUCH COVERAGE SHALL NOT BE SUBJECT TO THE REIMBURSEMENT PERIOD LIMITA-
TION OR MINIMUM PERIOD OF COVERAGE LIMITATION APPLICABLE TO MATERNITY
CARE COVERAGE.
(E) COVERAGE UNDER THIS PARAGRAPH SHALL NOT RESTRICT OR ELIMINATE
EXISTING COVERAGE PROVIDED BY THE POLICY AND NOTHING IN THIS PARAGRAPH
SHALL BE CONSTRUED TO DENY OR RESTRICT IN ANY WAY ANY EXISTING RIGHT OR
BENEFIT PROVIDED UNDER LAW OR BY CONTRACT.
S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 5-a to read as follows:
(5-A) (A) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIV-
ERY IN THIS STATE WHICH PROVIDES HOSPITAL, SURGICAL OR MEDICAL COVERAGE
AND WHICH OFFERS MATERNITY CARE COVERAGE PURSUANT TO PARAGRAPH FIVE OF
THIS SUBSECTION SHALL ALSO PROVIDE COVERAGE FOR PREGNANCY TERMINATION
PROCEDURES WHICH ARE PERFORMED BY A LICENSED PHYSICIAN, UPON THE POLICY
BENEFICIARY CERTIFICATE HOLDER OR UPON HIS SPOUSE OR UPON A NONSPOUSE
WHO IS DEPENDENT UPON THE POLICY BENEFICIARY CERTIFICATE HOLDER, IN ANY
LICENSED HOSPITAL OR MEDICAL FACILITY APPROVED BY THE STATE COMMISSIONER
OF HEALTH, TO THE SAME EXTENT THAT COVERAGE IS PROVIDED FOR ILLNESS OR
DISEASE UNDER THE POLICY, SUBJECT TO THE PROVISIONS OF THIS PARAGRAPH.
(B) PROVISION FOR SUCH COVERAGE SHALL BE SUBJECT TO ANY GUIDELINES
WHICH ARE NOW OR HEREAFTER ISSUED BY THE MEDICAL SPECIALTY SOCIETIES
RECOGNIZED BY THE AMERICAN BOARD OF MEDICAL SPECIALTIES OF OBSTETRICS
AND GYNECOLOGY, FOR PREGNANCY TERMINATIONS AND ABORTIONS.
(C) SUCH COVERAGE SHALL BE PROVIDED IN A MANNER WHICH ENSURES THE
CONFIDENTIALITY AND PRIVACY OF THE OCCURRENCE OF THE PROCEDURES
PERFORMED TO THE PERSON FOR WHOM COVERAGE IS PROVIDED.
(D) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE
AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT
WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY, BUT
SUCH COVERAGE SHALL NOT BE SUBJECT TO THE REIMBURSEMENT PERIOD LIMITA-
TION OR MINIMUM PERIOD OF COVERAGE LIMITATION APPLICABLE TO MATERNITY
CARE COVERAGE.
(E) COVERAGE UNDER THIS PARAGRAPH SHALL NOT RESTRICT OR ELIMINATE
EXISTING COVERAGE PROVIDED BY THE POLICY AND NOTHING IN THIS PARAGRAPH
SHALL BE CONSTRUED TO DENY OR RESTRICT IN ANY WAY ANY EXISTING RIGHT OR
BENEFIT PROVIDED UNDER LAW OR BY CONTRACT.
S 3. Section 4303 of the insurance law is amended by adding a new
subsection (c-1) to read as follows:
(C-1) (A) EVERY CONTRACT ISSUED BY A CORPORATION SUBJECT TO THE
PROVISIONS OF THIS ARTICLE WHICH PROVIDES HOSPITAL SERVICE, MEDICAL
EXPENSE INDEMNITY, OR BOTH, AND WHICH OFFERS MATERNITY CARE COVERAGE
PURSUANT TO SUBSECTION (C) OF THIS SECTION SHALL ALSO PROVIDE COVERAGE
FOR PREGNANCY TERMINATION PROCEDURES WHICH ARE PERFORMED BY A LICENSED
PHYSICIAN, UPON THE CONTRACT BENEFICIARY CERTIFICATE HOLDER OR UPON HIS
SPOUSE OR UPON A NONSPOUSE WHO IS DEPENDENT UPON THE CONTRACT BENEFICI-
ARY CERTIFICATE HOLDER, IN ANY LICENSED HOSPITAL OR MEDICAL FACILITY
APPROVED BY THE STATE COMMISSIONER OF HEALTH, TO THE SAME EXTENT THAT
COVERAGE IS PROVIDED FOR ILLNESS OR DISEASE UNDER THE CONTRACT, SUBJECT
TO THE PROVISIONS OF THIS SUBSECTION.
(B) PROVISION FOR SUCH COVERAGE SHALL BE SUBJECT TO ANY GUIDELINES
WHICH ARE NOW OR HEREAFTER ISSUED BY THE MEDICAL SPECIALTY SOCIETIES
RECOGNIZED BY THE AMERICAN BOARD OF MEDICAL SPECIALTIES OF OBSTETRICS
AND GYNECOLOGY, FOR PREGNANCY TERMINATIONS AND ABORTIONS.
A. 2945 3
(C) SUCH COVERAGE SHALL BE PROVIDED IN A MANNER WHICH ENSURES THE
CONFIDENTIALITY AND PRIVACY OF THE OCCURRENCE OF THE PROCEDURES
PERFORMED TO THE PERSON FOR WHOM COVERAGE IS PROVIDED.
(D) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE
AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT
WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN CONTRACT, BUT
SUCH COVERAGE SHALL NOT BE SUBJECT TO THE REIMBURSEMENT PERIOD LIMITA-
TION OR MINIMUM PERIOD OF COVERAGE LIMITATION APPLICABLE TO MATERNITY
CARE COVERAGE.
(E) COVERAGE UNDER THIS SUBSECTION SHALL NOT RESTRICT OR ELIMINATE
EXISTING COVERAGE PROVIDED BY THE CONTRACT AND NOTHING IN THIS
SUBSECTION SHALL BE CONSTRUED TO DENY OR RESTRICT IN ANY WAY ANY EXIST-
ING RIGHT OR BENEFIT PROVIDED UNDER LAW OR BY CONTRACT.
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 only apply to
policies and contracts issued, renewed, modified, altered or amended on
or after such date.