S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6460
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               March 7, 2019
                                ___________
 
 Introduced  by  M. of A. FAHY -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the insurance  law,  in  relation  to  health  insurance
   coverage for craniofacial disorders
 
   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 35 to read as follows:
   (35)(A)  EVERY  POLICY  DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
 WHICH PROVIDES MEDICAL COVERAGE THAT  INCLUDES  COVERAGE  FOR  PHYSICIAN
 SERVICES  IN  A PHYSICIAN'S OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR
 MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE  SHALL  PROVIDE  COVERAGE
 FOR  DIAGNOSIS AND MEDICALLY NECESSARY TREATMENT, INCLUDING SURGICAL AND
 NONSURGICAL PROCEDURES, FOR A MUSCULOSKELETAL DISORDER THAT AFFECTS  ANY
 BONE  OR  JOINT IN THE FACE, NECK OR HEAD AND IS THE RESULT OF ACCIDENT,
 TRAUMA, CONGENITAL DEFECT, DEVELOPMENTAL DEFECT, OR  PATHOLOGY.  SUBJECT
 TO  SUBPARAGRAPH  (B) OF THIS PARAGRAPH, THIS COVERAGE SHALL BE THE SAME
 AS THAT PROVIDED UNDER THE HEALTH INSURANCE PLAN FOR  ANY  OTHER  MUSCU-
 LOSKELETAL  DISORDER  IN THE BODY AND MAY BE PROVIDED WHEN PRESCRIBED OR
 ADMINISTERED BY A PHYSICIAN OR A DENTIST. THIS PARAGRAPH  SHALL  NOT  BE
 CONSTRUED  TO  REQUIRE COVERAGE FOR DENTAL SERVICES FOR THE DIAGNOSIS OR
 TREATMENT OF DENTAL DISORDERS OR DENTAL  PATHOLOGY  PRIMARILY  AFFECTING
 THE GUMS, TEETH, OR ALVEOLAR RIDGE.
   (B)  A  REFERRAL  FROM  A HEALTH CARE PROVIDER UNDER CONTRACT WITH THE
 POLICY MAY BE REQUIRED.
   § 2. Subsection (k) of section 3221 of the insurance law is amended by
 adding a new paragraph 22 to read as follows:
   (22)(A) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY
 IN THIS STATE WHICH PROVIDES MEDICAL COVERAGE THAT INCLUDES COVERAGE FOR
 PHYSICIAN SERVICES IN A PHYSICIAN'S OFFICE OR MAJOR MEDICAL  OR  SIMILAR
 COMPREHENSIVE-TYPE  COVERAGE  SHALL  PROVIDE  COVERAGE FOR DIAGNOSIS AND
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD10293-01-9

 A. 6460                             2
 
 MEDICALLY NECESSARY TREATMENT, INCLUDING SURGICAL AND NONSURGICAL PROCE-
 DURES, FOR A MUSCULOSKELETAL DISORDER THAT AFFECTS ANY BONE OR JOINT  IN
 THE FACE, NECK OR HEAD AND IS THE RESULT OF ACCIDENT, TRAUMA, CONGENITAL
 DEFECT,  DEVELOPMENTAL DEFECT, OR PATHOLOGY. SUBJECT TO SUBPARAGRAPH (B)
 OF THIS PARAGRAPH, THIS COVERAGE SHALL BE  THE  SAME  AS  THAT  PROVIDED
 UNDER  THE  HEALTH INSURANCE PLAN FOR ANY OTHER MUSCULOSKELETAL DISORDER
 IN THE BODY AND MAY BE PROVIDED WHEN PRESCRIBED  OR  ADMINISTERED  BY  A
 PHYSICIAN OR A DENTIST. THIS PARAGRAPH SHALL NOT BE CONSTRUED TO REQUIRE
 COVERAGE  FOR  DENTAL  SERVICES FOR THE DIAGNOSIS OR TREATMENT OF DENTAL
 DISORDERS OR DENTAL PATHOLOGY PRIMARILY AFFECTING THE  GUMS,  TEETH,  OR
 ALVEOLAR RIDGE.
   (B)  A  REFERRAL  FROM  A HEALTH CARE PROVIDER UNDER CONTRACT WITH THE
 POLICY MAY BE REQUIRED.
   § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
 subsection (ss) to read as follows:
   (SS)(1)  A  HOSPITAL  SERVICE  CORPORATION,  MEDICAL EXPENSE INDEMNITY
 CORPORATION OR HEALTH SERVICE CORPORATION WHICH PROVIDES MEDICAL  COVER-
 AGE  THAT  INCLUDES  COVERAGE  FOR  PHYSICIAN  SERVICES IN A PHYSICIAN'S
 OFFICE OR MAJOR MEDICAL OR  SIMILAR  COMPREHENSIVE-TYPE  COVERAGE  SHALL
 PROVIDE  COVERAGE  FOR  DIAGNOSIS  AND  MEDICALLY  NECESSARY  TREATMENT,
 INCLUDING SURGICAL AND NONSURGICAL  PROCEDURES,  FOR  A  MUSCULOSKELETAL
 DISORDER THAT AFFECTS ANY BONE OR JOINT IN THE FACE, NECK OR HEAD AND IS
 THE RESULT OF ACCIDENT, TRAUMA, CONGENITAL DEFECT, DEVELOPMENTAL DEFECT,
 OR PATHOLOGY. SUBJECT TO PARAGRAPH TWO OF THIS SUBSECTION, THIS COVERAGE
 SHALL  BE  THE SAME AS THAT PROVIDED UNDER THE HEALTH INSURANCE PLAN FOR
 ANY OTHER MUSCULOSKELETAL DISORDER IN THE BODY AND MAY BE PROVIDED  WHEN
 PRESCRIBED  OR ADMINISTERED BY A PHYSICIAN OR A DENTIST. THIS SUBSECTION
 SHALL NOT BE CONSTRUED TO REQUIRE COVERAGE FOR DENTAL SERVICES  FOR  THE
 DIAGNOSIS OR TREATMENT OF DENTAL DISORDERS OR DENTAL PATHOLOGY PRIMARILY
 AFFECTING THE GUMS, TEETH, OR ALVEOLAR RIDGE.
   (2)  A  REFERRAL  FROM  A HEALTH CARE PROVIDER UNDER CONTRACT WITH THE
 POLICY MAY BE REQUIRED.
   § 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 apply to all
 policies issued, renewed, altered or modified on or after such date.