S T A T E O F N E W Y O R K
________________________________________________________________________
5116
2013-2014 Regular Sessions
I N A S S E M B L Y
February 20, 2013
___________
Introduced by M. of A. CURRAN -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to coverage of primary
and preventative obstetric and gynecological care; and repealing
certain provisions of such law relating thereto
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subparagraph (B) of paragraph 11 of subsection (l) of
section 3221 of the insurance law, as amended by chapter 219 of the laws
of 2011, is amended to read as follows:
(B) Such coverage required pursuant to subparagraph (A) or (C) of this
paragraph may NOT 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].
S 2. Subparagraph (D) of paragraph 1 of subsection (p) of section 4303
of the insurance law, as amended by chapter 219 of the laws of 2011, is
amended to read as follows:
(D) The coverage required in this paragraph or paragraph two of this
subsection 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].
S 3. Subparagraph (C) of paragraph 14 of subsection (l) of section
3221 of the insurance law, as amended by chapter 219 of the laws of
2011, is amended to read as follows:
(C) Such coverage required pursuant to subparagraph (A) or (B) of this
paragraph may NOT 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].
S 4. Paragraph 1 of subsection (t) of section 4303 of the insurance
law, as amended by chapter 219 of the laws of 2011, is amended to read
as follows:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD08438-01-3
A. 5116 2
(1) A medical expense indemnity corporation, a hospital service corpo-
ration or a health service corporation that provides coverage for hospi-
tal, surgical, or medical care shall provide coverage for an annual
cervical cytology screening for cervical cancer and its precursor states
for women aged eighteen and older. Such coverage required by this para-
graph may NOT 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].
S 5. The opening paragraph of paragraph 13 of subsection (k) of
section 3221 of the insurance law, as amended by chapter 219 of the laws
of 2011, is amended to read as follows:
Every group or blanket policy delivered or issued for delivery in this
state that provides major medical or similar comprehensive-type coverage
shall provide such coverage for bone mineral density measurements or
tests, and if such contract otherwise includes coverage for prescription
drugs, drugs and devices approved by the federal food and drug adminis-
tration or generic equivalents as approved substitutes. In determining
appropriate coverage provided by subparagraphs (A), (B) and (C) of this
paragraph, the insurer or health maintenance organization shall adopt
standards that include the criteria of the federal Medicare program and
the criteria of the national institutes of health for the detection AND
TREATMENT of osteoporosis, provided that such coverage shall be further
determined as follows:
S 6. The opening paragraph of subsection (bb) of section 4303 of the
insurance law, as amended by chapter 219 of the laws of 2011, is amended
to read as follows:
A health service corporation or a medical service expense indemnity
corporation that provides major medical or similar comprehensive-type
coverage shall provide such coverage for bone mineral density measure-
ments or tests, and if such contract otherwise includes coverage for
prescription drugs, drugs and devices approved by the federal food and
drug administration or generic equivalents as approved substitutes. In
determining appropriate coverage provided by paragraphs one, two and
three of this subsection, the insurer or health maintenance organization
shall adopt standards that include the criteria of the federal Medicare
program and the criteria of the national institutes of health for the
detection AND TREATMENT of osteoporosis, provided that such coverage
shall be further determined as follows:
S 7. Subsection (cc) of section 4303 of the insurance law is REPEALED
and a new subsection (cc) is added to read as follows:
(CC) EVERY CONTRACT WHICH PROVIDES COVERAGE FOR PRESCRIPTION DRUGS
SHALL INCLUDE COVERAGE FOR THE COST OF CONTRACEPTIVE DRUGS OR DEVICES
APPROVED BY THE FEDERAL FOOD AND DRUG ADMINISTRATION OR GENERIC EQUIV-
ALENTS APPROVED AS SUBSTITUTES BY SUCH FOOD AND DRUG ADMINISTRATION
UNDER THE PRESCRIPTION OF A HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO
PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW. THE COVERAGE REQUIRED
BY THIS SECTION SHALL BE INCLUDED IN CONTRACTS AND CERTIFICATES ONLY
THROUGH THE ADDITION OF A RIDER. THE PER MEMBER PREMIUM RATE FOR COVER-
AGE PROVIDED BY THIS RIDER SHALL BE THE SAME FOR ALL CONTRACTS AND
CERTIFICATES OF AN INSURER OR HEALTH MAINTENANCE ORGANIZATION TO WHICH
THE RIDER IS ATTACHED, EXCEPT THAT AN INSURER OR HEALTH MAINTENANCE
ORGANIZATION MAY RATE THE RIDERS ISSUED WITH ITS SMALL GROUP POLICIES
SEPARATELY FROM THE RIDERS ISSUED WITH ITS LARGE GROUP CONTRACTS.
(1) PROVIDED, HOWEVER, IF THE GROUP OR ENTITY, ON WHOSE BEHALF THE
CONTRACT IS ISSUED IS OPERATED, SUPERVISED OR CONTROLLED BY OR IN
CONNECTION WITH A RELIGIOUS ORGANIZATION OR DENOMINATIONAL GROUP OR
A. 5116 3
ENTITY, THEN NOTHING IN THIS SUBSECTION SHALL REQUIRE THE CONTRACT TO
COVER ANY CONTRACEPTIVE DRUGS OR DEVICES THAT ARE CONTRARY TO THE RELI-
GIOUS TENETS OF SUCH GROUP OR ENTITY. IF THE INSURER OR HEALTH MAINTE-
NANCE ORGANIZATION DELIVERING THE CONTRACT OR ISSUING THE CONTRACT FOR
DELIVERY IN THIS STATE IS OPERATED, SPONSORED OR CONTROLLED BY OR IN
CONNECTION WITH A RELIGIOUS ORGANIZATION OR DENOMINATIONAL GROUP OR
ENTITY, THEN NOTHING IN THIS SUBSECTION SHALL REQUIRE THE CONTRACT TO
COVER ANY CONTRACEPTIVE DRUGS OR DEVICES THAT ARE CONTRARY TO THE RELI-
GIOUS TENETS OF SUCH INSURER OR HEALTH MAINTENANCE ORGANIZATION.
(2)(A) WHERE A GROUP CONTRACTHOLDER MAKES AN ELECTION NOT TO PURCHASE
COVERAGE FOR CONTRACEPTIVE DRUGS OR DEVICES IN ACCORDANCE WITH PARAGRAPH
ONE OF THIS SUBSECTION, EACH ENROLLEE COVERED UNDER THE CONTRACT ISSUED
TO THAT GROUP CONTRACTHOLDER SHALL HAVE THE RIGHT TO DIRECTLY PURCHASE
THE RIDER REQUIRED BY THIS SUBSECTION FROM THE INSURER OR HEALTH MAINTE-
NANCE ORGANIZATION WHICH ISSUED THE GROUP CONTRACT. THE ENROLLEE'S COST
OF PURCHASING SUCH RIDER SHALL BE THE SAME AS THAT WHICH WOULD HAVE BEEN
APPLICABLE HAD THE GROUP CONTRACTHOLDER NOT EXERCISED SUCH ELECTION NOT
TO PURCHASE COVERAGE.
(B) WHERE A GROUP CONTRACTHOLDER MAKES AN ELECTION NOT TO PURCHASE
COVERAGE FOR CONTRACEPTIVE DRUGS OR DEVICES IN ACCORDANCE WITH PARAGRAPH
ONE OF THIS SUBSECTION, THE INSURER OR HEALTH MAINTENANCE ORGANIZATION
THAT PROVIDES SUCH COVERAGE SHALL PROVIDE WRITTEN NOTICE TO ENROLLEES
UPON ENROLLMENT WITH THE INSURER OR HEALTH MAINTENANCE ORGANIZATION OF
THEIR RIGHT TO DIRECTLY PURCHASE A RIDER FOR COVERAGE FOR THE COST OF
CONTRACEPTIVE DRUGS OR DEVICES. THE NOTICE SHALL ALSO ADVISE THE ENROL-
LEES OF THE ADDITIONAL PREMIUM FOR SUCH COVERAGE.
(3) SUCH COVERAGE MAY BE SUBJECT TO REASONABLE ANNUAL DEDUCTIBLES AND
COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS
ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER DRUGS OR DEVICES COVERED
UNDER THE POLICY.
S 8. The second undesignated paragraph of paragraph 26 of subsection
(b) of section 4322 of the insurance law, as amended by chapter 219 of
the laws of 2011, is amended to read as follows:
In determining appropriate coverage provided by subparagraphs (A), (B)
and (C) of this paragraph, the insurer or health maintenance organiza-
tion shall adopt standards that include the criteria of the federal
Medicare program and the criteria of the national institutes of health
for the detection AND TREATMENT of osteoporosis, provided that such
coverage shall be further determined as follows:
S 9. Paragraph 16 of subsection (l) of section 3221 of the insurance
law is REPEALED and a new paragraph 16 is added to read as follows:
(16) EVERY GROUP OR BLANKET POLICY WHICH PROVIDES COVERAGE FOR
PRESCRIPTION DRUGS SHALL INCLUDE COVERAGE FOR THE COST OF CONTRACEPTIVE
DRUGS OR DEVICES APPROVED BY THE FEDERAL FOOD AND DRUG ADMINISTRATION OR
GENERIC EQUIVALENTS APPROVED AS SUBSTITUTES BY SUCH FOOD AND DRUG ADMIN-
ISTRATION UNDER THE PRESCRIPTION OF A HEALTH CARE PROVIDER LEGALLY
AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW. THE
COVERAGE REQUIRED BY THIS SECTION SHALL BE INCLUDED IN POLICIES AND
CERTIFICATES ONLY THROUGH THE ADDITION OF A RIDER. THE PER MEMBER PREMI-
UM RATE FOR COVERAGE PROVIDED BY THIS RIDER SHALL BE THE SAME FOR ALL
POLICIES AND CERTIFICATES OF AN INSURER TO WHICH THE RIDER IS ATTACHED,
EXCEPT THAT AN INSURER MAY RATE THE RIDERS ISSUED WITH ITS SMALL GROUP
POLICIES SEPARATELY FROM THE RIDERS ISSUED WITH ITS LARGE GROUP POLI-
CIES.
(A) PROVIDED, HOWEVER, IF THE GROUP OR ENTITY, ON WHOSE BEHALF THE
CONTRACT IS ISSUED IS OPERATED, SUPERVISED OR CONTROLLED BY OR IN
A. 5116 4
CONNECTION WITH A RELIGIOUS ORGANIZATION OR DENOMINATIONAL GROUP OR
ENTITY, THEN NOTHING IN THIS PARAGRAPH SHALL REQUIRE THE CONTRACT TO
COVER ANY CONTRACEPTIVE DRUGS OR DEVICES THAT ARE CONTRARY TO THE RELI-
GIOUS TENETS OF SUCH GROUP OR ENTITY. IF THE INSURER OR HEALTH MAINTE-
NANCE ORGANIZATION DELIVERING THE CONTRACT OR ISSUING THE CONTRACT FOR
DELIVERY IN THIS STATE IS OPERATED, SPONSORED OR CONTROLLED BY OR IN
CONNECTION WITH A RELIGIOUS ORGANIZATION OR DENOMINATIONAL GROUP OR
ENTITY, THEN NOTHING IN THIS PARAGRAPH SHALL REQUIRE THE CONTRACT TO
COVER ANY CONTRACEPTIVE DRUGS OR DEVICES THAT ARE CONTRARY TO THE RELI-
GIOUS TENETS OF SUCH INSURER OR HEALTH MAINTENANCE ORGANIZATION.
(B) (I) WHERE A GROUP POLICYHOLDER MAKES AN ELECTION NOT TO PURCHASE
COVERAGE FOR CONTRACEPTIVE DRUGS OR DEVICES IN ACCORDANCE WITH SUBPARA-
GRAPH (A) OF THIS PARAGRAPH EACH CERTIFICATEHOLDER COVERED UNDER THE
POLICY ISSUED TO THAT GROUP POLICYHOLDER SHALL HAVE THE RIGHT TO DIRECT-
LY PURCHASE THE RIDER REQUIRED BY THIS PARAGRAPH FROM THE INSURER WHICH
ISSUED THE GROUP POLICY. THE CERTIFICATEHOLDER'S COST OF PURCHASING SUCH
RIDER SHALL BE THE SAME AS THAT WHICH WOULD HAVE BEEN APPLICABLE HAD THE
GROUP POLICYHOLDER NOT EXERCISED SUCH ELECTION NOT TO PURCHASE COVERAGE.
(II) WHERE A GROUP POLICYHOLDER MAKES AN ELECTION NOT TO PURCHASE
COVERAGE FOR CONTRACEPTIVE DRUGS OR DEVICES IN ACCORDANCE WITH SUBPARA-
GRAPH (A) OF THIS PARAGRAPH, THE INSURER THAT PROVIDES SUCH COVERAGE
SHALL PROVIDE WRITTEN NOTICE TO CERTIFICATEHOLDERS UPON ENROLLMENT WITH
THE INSURER OF THEIR RIGHT TO DIRECTLY PURCHASE A RIDER FOR COVERAGE FOR
THE COST OF CONTRACEPTIVE DRUGS OR DEVICES. THE NOTICE SHALL ALSO ADVISE
THE CERTIFICATEHOLDERS OF THE ADDITIONAL PREMIUM FOR SUCH COVERAGE.
(C) SUCH COVERAGE MAY BE SUBJECT TO REASONABLE ANNUAL DEDUCTIBLES AND
COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS
ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER DRUGS OR DEVICES COVERED
UNDER THE POLICY.
S 10. This act shall take effect on the sixtieth day after it shall
have become a law and shall apply to all policies issued, renewed, modi-
fied or altered on or after such date.