The New York State Senate

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

                                  3101

                       2019-2020 Regular Sessions

                            I N  S E N A T E

                            February 4, 2019
                               ___________

Introduced  by  Sen.  BIAGGI -- read twice and ordered printed, and when
  printed to be committed 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. Such group policies
issued or delivered in this state 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 policy, including network limitations  or  variations,  exclu-
sions,  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
depression,  bipolar  disorder,  delusional  disorders,  panic disorder,

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

                                                           LBD01128-01-9

S. 3101                             2

obsessive compulsive disorders[, bulimia, and  anorexia]  OR  AN  EATING
DISORDER.
  (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.
  § 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. Such hospi-
tal service corporation or health service corporation 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 contract, including  network  limitations
or  variations,  exclusions,  co-pays, coinsurance, 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,
obsessive  compulsive  disorders[,  anorexia,  and bulimia] OR AN EATING
DISORDER.
  (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.
  § 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. 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 condi-
tions otherwise applicable under the contract, including network limita-
tions  or  variations,  exclusions, co-pays, coinsurance, 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  deduct-

S. 3101                             3

ibles,  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,
obsessive  compulsive  disorder[,  anorexia,  and  bulimia] OR AN EATING
DISORDER.
  (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.
  § 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.