The New York State Senate

                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  8246

                       2019-2020 Regular Sessions

                          I N  A S S E M B L Y

                              June 10, 2019
                               ___________

Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
  Committee on Insurance

AN ACT to amend the insurance law, in relation to calculating an insured
  individual's overall contribution to any out-of-pocket maximum or  any
  cost-sharing requirement

  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 36 to read as follows:
  (36)  ANY  POLICY  THAT PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL
APPLY ANY THIRD-PARTY PAYMENTS, FINANCIAL ASSISTANCE, DISCOUNT,  VOUCHER
OR  OTHER  PRICE REDUCTION INSTRUMENT FOR OUT-OF-POCKET EXPENSES MADE ON
BEHALF OF AN INSURED INDIVIDUAL FOR THE COST OF  PRESCRIPTION  DRUGS  TO
THE INSURED'S DEDUCTIBLE, COPAYMENT, COINSURANCE, OUT-OF-POCKET MAXIMUM,
OR  ANY  OTHER  COST-SHARING  REQUIREMENT  WHEN CALCULATING SUCH INSURED
INDIVIDUAL'S OVERALL CONTRIBUTION TO ANY OUT-OF-POCKET  MAXIMUM  OR  ANY
COST-SHARING REQUIREMENT.
  § 2. Subsection (l) of section 3221 of the insurance law is amended by
adding a new paragraph 21 to read as follows:
  (21) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY IN
THIS STATE THAT PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL APPLY ANY
THIRD-PARTY  PAYMENTS,  FINANCIAL ASSISTANCE, DISCOUNT, VOUCHER OR OTHER
PRICE REDUCTION INSTRUMENT FOR OUT-OF-POCKET EXPENSES MADE ON BEHALF  OF
AN  INSURED  INDIVIDUAL  FOR  THE  COST  OF  PRESCRIPTION  DRUGS  TO THE
INSURED'S DEDUCTIBLE, COPAYMENT, COINSURANCE, OUT-OF-POCKET MAXIMUM,  OR
ANY  OTHER  COST-SHARING REQUIREMENT WHEN CALCULATING SUCH INSURED INDI-
VIDUAL'S OVERALL CONTRIBUTION TO ANY OUT-OF-POCKET MAXIMUM OR ANY  COST-
SHARING REQUIREMENT.
  §  3.  Section  4303  of  the insurance law is amended by adding a new
subsection (ss) to read as follows:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD13146-01-9

A. 8246                             2

  (SS) EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION,
HOSPITAL  SERVICE  CORPORATION,  OR  HEALTH  SERVICE  CORPORATION   THAT
PROVIDES  COVERAGE  FOR  PRESCRIPTION  DRUGS SHALL APPLY ANY THIRD-PARTY
PAYMENTS,  FINANCIAL  ASSISTANCE,  DISCOUNT,  VOUCHER  OR  OTHER   PRICE
REDUCTION  INSTRUMENT  FOR  OUT-OF-POCKET  EXPENSES MADE ON BEHALF OF AN
INSURED INDIVIDUAL FOR THE COST OF PRESCRIPTION DRUGS TO  THE  INSURED'S
DEDUCTIBLE,  COPAYMENT, COINSURANCE, OUT-OF-POCKET MAXIMUM, OR ANY OTHER
COST-SHARING REQUIREMENT  WHEN  CALCULATING  SUCH  INSURED  INDIVIDUAL'S
OVERALL  CONTRIBUTION  TO  ANY OUT-OF-POCKET MAXIMUM OR ANY COST-SHARING
REQUIREMENT.
  § 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 and contracts issued, renewed, modified, altered or amended  on
or after such date.