S T A T E O F N E W Y O R K
________________________________________________________________________
6396
2017-2018 Regular Sessions
I N A S S E M B L Y
March 6, 2017
___________
Introduced by M. of A. ROZIC, COLTON, ENGLEBRIGHT, ORTIZ, SIMON -- read
once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to coverage for eating
disorders
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subparagraph (B) of paragraph 5 of subsection (1) of
section 3221 of the insurance law, as amended by chapter 502 of the laws
of 2007, is amended to read as follows:
(B) (i) Every insurer delivering a group or school blanket policy or
issuing a group or school blanket policy for delivery, in this state,
which provides coverage for inpatient hospital care or coverage for
physician services, shall provide comparable coverage for adults and
children with biologically based mental illness OR AN EATING DISORDER.
Such group policies issued or delivered in this state shall also provide
such comparable coverage for children with serious emotional disturb-
ances. Such coverage shall be provided under the terms and conditions
otherwise applicable under the policy, including network limitations or
variations, exclusions, co-pays, coinsurance, deductibles or other
specific cost sharing mechanisms. Provided further, where a policy
provides both in-network and out-of-network benefits, the out-of-network
benefits may have different coinsurance, co-pays, or deductibles, than
the in-network benefits, regardless of whether the policy is written
under one license or two licenses.
(ii) For purposes of this paragraph, the term "biologically based
mental illness" means a mental, nervous, or emotional condition that is
caused by a biological disorder of the brain and results in a clinically
significant, psychological syndrome or pattern that substantially limits
the functioning of the person with the illness. Such biologically based
mental illnesses are defined as schizophrenia/psychotic disorders, major
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD06526-01-7
A. 6396 2
depression, bipolar disorder, delusional disorders, panic disorder[,] OR
obsessive compulsive disorders[, bulimia, and anorexia].
(III) FOR PURPOSES OF THIS PARAGRAPH, THE TERM "EATING DISORDER" MEANS
PICA, RUMINATION DISORDER, AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER,
ANOREXIA NERVOSA, BULIMIA NERVOSA, BINGE EATING DISORDER, OTHER SPECI-
FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
IN THE MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF
MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION WHERE
DIAGNOSED BY A LICENSED PHYSICIAN, PSYCHIATRIST, PSYCHOLOGIST, CLINICAL
SOCIAL WORKER, LICENSED MARITAL AND FAMILY THERAPIST, OR PROFESSIONAL
COUNSELOR DULY LICENSED IN THE STATE WHERE HE OR SHE PRACTICES AND
ACTING WITHIN THEIR APPLICABLE SCOPE OF PRACTICE IN THE STATE WHERE HE
OR SHE PRACTICES.
§ 2. Paragraph 2 of subsection (g) of section 4303 of the insurance
law, as amended by chapter 502 of the laws of 2007, is amended to read
as follows:
(2) (A) A hospital service corporation or a health service corpo-
ration, which provides group, group remittance or school blanket cover-
age for inpatient hospital care, shall provide comparable coverage for
adults and children with biologically based mental illness OR AN EATING
DISORDER. Such hospital service corporation or health service corpo-
ration shall also provide such comparable coverage for children with
serious emotional disturbances. Such coverage shall be provided under
the terms and conditions otherwise applicable under the contract,
including network limitations or variations, exclusions, co-pays, coin-
surance, deductibles or other specific cost sharing mechanisms. Provided
further, where a contract provides both in-network and out-of-network
benefits, the out-of-network benefits may have different coinsurance,
co-pays, or deductibles, than the in-network benefits, regardless of
whether the contract is written under one license or two licenses.
(B) For purposes of this subsection, the term "biologically based
mental illness" means a mental, nervous, or emotional condition that is
caused by a biological disorder of the brain and results in a clinically
significant, psychological syndrome or pattern that substantially limits
the functioning of the person with the illness. Such biologically based
mental illnesses are defined as schizophrenia/psychotic disorders, major
depression, bipolar disorder, delusional disorders, panic disorder[,] OR
obsessive compulsive disorders[, anorexia, and bulimia].
(C) FOR PURPOSES OF THIS SUBSECTION, THE TERM "EATING DISORDER" MEANS
PICA, RUMINATION DISORDER, AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER,
ANOREXIA NERVOSA, BULIMIA NERVOSA, BINGE EATING DISORDER, OTHER SPECI-
FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
IN THE MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF
MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION WHERE
DIAGNOSED BY A LICENSED PHYSICIAN, PSYCHIATRIST, PSYCHOLOGIST, CLINICAL
SOCIAL WORKER, LICENSED MARITAL AND FAMILY THERAPIST, OR PROFESSIONAL
COUNSELOR DULY LICENSED IN THE STATE WHERE HE OR SHE PRACTICES AND
ACTING WITHIN THEIR APPLICABLE SCOPE OF PRACTICE IN THE STATE WHERE HE
OR SHE PRACTICES.
§ 3. Paragraph 2 of subsection (h) of section 4303 of the insurance
law, as amended by chapter 502 of the laws of 2007, is amended to read
as follows:
(2) (A) A medical expense indemnity corporation or a health service
corporation, which provides group, group remittance or school blanket
coverage for physician services, shall provide comparable coverage for
adults and children with biologically based mental illness OR AN EATING
A. 6396 3
DISORDER. Such medical expense indemnity corporation or health service
corporation shall also provide such comparable coverage for children
with serious emotional disturbances. Such coverage shall be provided
under the terms and conditions otherwise applicable under the contract,
including network limitations or variations, exclusions, co-pays, coin-
surance, deductibles or other specific cost sharing mechanisms. Provided
further, where a contract provides both in-network and out-of-network
benefits, the out-of-network benefits may have different coinsurance,
co-pays, or deductibles, than the in-network benefits, regardless of
whether the contract is written under one license or two licenses.
(B) For purposes of this subsection, the term "biologically based
mental illness" means a mental, nervous, or emotional condition that is
caused by a biological disorder of the brain and results in a clinically
significant, psychological syndrome or pattern that substantially limits
the functioning of the person with the illness. Such biologically based
mental illnesses are defined as schizophrenia/psychotic disorders, major
depression, bipolar disorder, delusional disorders, panic disorder[,] OR
obsessive compulsive disorder[, anorexia, and bulimia].
(C) FOR PURPOSES OF THIS SUBSECTION, THE TERM "EATING DISORDER" MEANS
PICA, RUMINATION DISORDER, AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER,
ANOREXIA NERVOSA, BULIMIA NERVOSA, BINGE EATING DISORDER, OTHER SPECI-
FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
IN THE MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF
MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION WHERE
DIAGNOSED BY A LICENSED PHYSICIAN, PSYCHIATRIST, PSYCHOLOGIST, CLINICAL
SOCIAL WORKER, LICENSED MARITAL AND FAMILY THERAPIST, OR PROFESSIONAL
COUNSELOR DULY LICENSED IN THE STATE WHERE HE OR SHE PRACTICES AND
ACTING WITHIN THEIR APPLICABLE SCOPE OF PRACTICE IN THE STATE WHERE HE
OR SHE PRACTICES.
§ 4. This act shall take effect on the ninetieth day after it shall
have become a law; provided, however, that the provisions of this act
shall apply to policies and contracts issued, renewed, modified, altered
or amended on or after such effective date.