S T A T E O F N E W Y O R K
________________________________________________________________________
2548
2017-2018 Regular Sessions
I N A S S E M B L Y
January 20, 2017
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Introduced by M. of A. LIFTON, JAFFEE, KAVANAGH, O'DONNELL,
PEOPLES-STOKES, ROSENTHAL -- Multi-Sponsored by -- M. of A. COLTON,
GALEF, GUNTHER -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to providing coverage for
family members of children who require psychiatric or psychological
services
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 34 to read as follows:
(34) (A) EVERY INSURER ISSUING A POLICY OF ACCIDENT AND HEALTH INSUR-
ANCE FOR DELIVERY IN THIS STATE WHICH PROVIDES COVERAGE FOR PSYCHIATRIC
OR PSYCHOLOGICAL SERVICES OR DIAGNOSIS OR TREATMENT OF MENTAL, NERVOUS
OR EMOTIONAL DISORDERS OR AILMENTS SHALL MAKE AVAILABLE AND PROVIDE
COVERAGE FOR FAMILY SESSIONS WHEN THE INSURED IS UNDER EIGHTEEN YEARS OF
AGE. IN THIS PARAGRAPH, "FAMILY SESSIONS" MEANS THERAPY SESSIONS DETER-
MINED AS NECESSARY BY A LICENSED PSYCHOLOGICAL PROFESSIONAL IN THE STATE
INVOLVING ANY FAMILY MEMBER OF AN INSURED.
(B) THE COVERAGE REQUIRED BY THIS PARAGRAPH SHALL INCLUDE TREATMENT AS
A FAMILY MEMBER PURSUANT TO SUCH FAMILY MEMBER'S OWN POLICY OR CONTRACT
PROVIDED SUCH FAMILY MEMBER (I) DOES NOT EXCEED THE ALLOWABLE NUMBER OF
FAMILY VISITS PROVIDED BY THE APPLICABLE POLICY OR CONTRACT, AND (II) IS
OTHERWISE ENTITLED TO COVERAGE PURSUANT TO SUCH FAMILY MEMBER'S APPLICA-
BLE POLICY OR CONTRACT.
§ 2. Subsection (l) of section 3221 of the insurance law is amended by
adding a new paragraph 20 to read as follows:
(20) (A) EVERY GROUP OR BLANKET POLICY WHICH PROVIDES COVERAGE FOR
PSYCHIATRIC OR PSYCHOLOGICAL SERVICES OR DIAGNOSIS OR TREATMENT OF
MENTAL, NERVOUS OR EMOTIONAL DISORDERS OR AILMENTS SHALL MAKE AVAILABLE
AND PROVIDE COVERAGE FOR FAMILY SESSIONS WHEN THE INSURED IS UNDER EIGH-
TEEN YEARS OF AGE. IN THIS PARAGRAPH, "FAMILY SESSIONS" MEANS THERAPY
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD07907-01-7
A. 2548 2
SESSIONS DETERMINED AS NECESSARY BY A LICENSED PSYCHOLOGICAL PROFES-
SIONAL IN THE STATE INVOLVING ANY FAMILY MEMBER OF AN INSURED.
(B) THE COVERAGE REQUIRED BY THIS PARAGRAPH SHALL INCLUDE TREATMENT AS
A FAMILY MEMBER PURSUANT TO SUCH FAMILY MEMBER'S OWN POLICY OR CONTRACT
PROVIDED SUCH FAMILY MEMBER (I) DOES NOT EXCEED THE ALLOWABLE NUMBER OF
FAMILY VISITS PROVIDED BY THE APPLICABLE POLICY OR CONTRACT, AND (II) IS
OTHERWISE ENTITLED TO COVERAGE PURSUANT TO SUCH FAMILY MEMBER'S APPLICA-
BLE POLICY OR CONTRACT.
§ 3. Subsection (i) of section 4303 of the insurance law, as amended
by chapter 230 of the laws of 2004, is amended to read as follows:
(i) A medical expense indemnity corporation or health service corpo-
ration which provides coverage for physicians, psychiatrists or psychol-
ogists for psychiatric or psychological services or for the diagnosis
and treatment of mental, nervous or emotional disorders and ailments,
however defined in such contract, must make available and if requested
by all persons holding individual contracts in a group whose premiums
are paid by a remitting agent or by the contract holder in the case of a
group contract issued pursuant to section four thousand three hundred
five of this article[,]: (A) provide the same coverage for such services
when performed by a licensed clinical social worker, within the lawful
scope of his or her practice, who is licensed pursuant to article one
hundred fifty-four of the education law. The state board for social work
shall maintain a list of all licensed clinical social workers qualified
for reimbursement under this subsection. Such coverage shall be made
available at the inception of all new contracts and, with respect to all
other contracts, at any anniversary date subject to evidence of insura-
bility. Written notice of the availability of such coverage shall be
delivered to the group remitting agent or group contract holder prior to
inception of such contract and annually thereafter, except that this
notice shall not be required where a policy covers two hundred or more
employees or where the benefit structure was the subject of collective
bargaining affecting persons who are employed in more than one state[.];
AND (B) MAKE AVAILABLE AND PROVIDE COVERAGE FOR FAMILY SESSIONS WHEN THE
INSURED IS UNDER EIGHTEEN YEARS OF AGE.
(I) IN THIS SUBSECTION, "FAMILY SESSIONS" MEANS THERAPY SESSIONS
DETERMINED AS NECESSARY BY A LICENSED PSYCHOLOGICAL PROFESSIONAL IN THE
STATE INVOLVING ANY FAMILY MEMBER OF AN INSURED.
(II) THE COVERAGE REQUIRED BY THIS SUBSECTION SHALL INCLUDE TREATMENT
AS A FAMILY MEMBER PURSUANT TO SUCH FAMILY MEMBER'S OWN POLICY OR
CONTRACT PROVIDED SUCH FAMILY MEMBER (1) DOES NOT EXCEED THE ALLOWABLE
NUMBER OF FAMILY VISITS PROVIDED BY THE APPLICABLE POLICY OR CONTRACT,
AND (2) IS OTHERWISE ENTITLED TO COVERAGE PURSUANT TO SUCH FAMILY
MEMBER'S APPLICABLE POLICY OR CONTRACT.
§ 4. This act shall take effect on the one hundred twentieth day after
it shall have become a law, except that any rule or regulation necessary
for the timely implementation of this act on its effective date shall be
promulgated on or before such date.