S T A T E O F N E W Y O R K
________________________________________________________________________
6263
2019-2020 Regular Sessions
I N S E N A T E
May 30, 2019
___________
Introduced by Sen. GOUNARDES -- 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 limiting co-payments
for insulin
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 15-a of subsection (i) of section 3216 of the
insurance law, as added by chapter 378 of the laws of 1993 such section
as renumbered and subparagraph (A) as amended by chapter 338 of the laws
of 2003, is amended to read as follows:
(15-a) (A) Every policy 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 include coverage for the following equipment and supplies for the
treatment of diabetes, if recommended or prescribed by a physician or
other licensed health care provider legally authorized to prescribe
under title eight of the education law: blood glucose monitors and blood
glucose monitors for the visually impaired, data management systems,
test strips for glucose monitors and visual reading and urine testing
strips, insulin, injection aids, cartridges for the visually impaired,
syringes, insulin pumps and appurtenances thereto, insulin infusion
devices, and oral agents for controlling blood sugar. In addition, the
commissioner of the department of health shall provide and periodically
update by rule or regulation a list of additional diabetes equipment and
related supplies such as are medically necessary for the treatment of
diabetes, for which there shall also be coverage. Such policies shall
also include coverage for diabetes self-management education to ensure
that persons with diabetes are educated as to the proper self-management
and treatment of their diabetic condition, including information on
proper diets. Such coverage for self-management education and education
relating to diet shall be limited to visits medically necessary upon the
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD13090-02-9
S. 6263 2
diagnosis of diabetes, where a physician diagnoses a significant change
in the patient's symptoms or conditions which necessitate changes in a
patient's self-management, or where reeducation or refresher education
is necessary. Such education may be provided by the physician or other
licensed health care provider legally authorized to prescribe under
title eight of the education law, or their staff, as part of an office
visit for diabetes diagnosis or treatment, or by a certified diabetes
nurse educator, certified nutritionist, certified dietitian or regis-
tered dietitian upon the referral of a physician or other licensed
health care provider legally authorized to prescribe under title eight
of the education law. Education provided by the certified diabetes nurse
educator, certified nutritionist, certified dietitian or registered
dietitian may be limited to group settings wherever practicable. Cover-
age for self-management education and education relating to diet shall
also include home visits when medically necessary.
(B) Such coverage may be subject to annual deductibles and coinsurance
as may be deemed appropriate by the superintendent and as are consistent
with those established for other benefits within a given policy;
PROVIDED, HOWEVER, THAT A COVERED PERSON SHALL NOT BE REQUIRED TO PAY AN
AMOUNT IN EXCESS OF ONE HUNDRED DOLLARS PER THIRTY DAY SUPPLY OF
PRESCRIPTION INSULIN REGARDLESS OF THE AMOUNT OR TYPE OF INSULIN NEEDED
TO FILL THE COVERED PERSON'S PRESCRIPTION, HOWEVER NOTHING SHALL PREVENT
AN INSURER FROM REDUCING SUCH MAXIMUM AMOUNT.
§ 2. Paragraph 7 of subsection (k) of section 3221 of the insurance
law, as amended by chapter 338 of the laws of 2003, is amended to read
as follows:
(7)(A) Every group or blanket accident and health insurance policy
issued 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 compre-
hensive-type coverage shall include coverage for the following equipment
and supplies for the treatment of diabetes, if recommended or prescribed
by a physician or other licensed health care provider legally authorized
to prescribe under title eight of the education law: blood glucose moni-
tors and blood glucose monitors for the visually impaired, data manage-
ment systems, test strips for glucose monitors and visual reading and
urine testing strips, insulin, injection aids, cartridges for the visu-
ally impaired, syringes, insulin pumps and appurtenances thereto, insu-
lin infusion devices, and oral agents for controlling blood sugar. In
addition, the commissioner of the department of health shall provide and
periodically update by rule or regulation a list of additional diabetes
equipment and related supplies such as are medically necessary for the
treatment of diabetes, for which there shall also be coverage. Such
policies shall also include coverage for diabetes self-management educa-
tion to ensure that persons with diabetes are educated as to the proper
self-management and treatment of their diabetic condition, including
information on proper diets. Such coverage for self-management education
and education relating to diet shall be limited to visits medically
necessary upon the diagnosis of diabetes, where a physician diagnoses a
significant change in the patient's symptoms or conditions which neces-
sitate changes in a patient's self-management, or where reeducation or
refresher education is necessary. Such education may be provided by the
physician or other licensed health care provider legally authorized to
prescribe under title eight of the education law, or their staff, as
part of an office visit for diabetes diagnosis or treatment, or by a
certified diabetes nurse educator, certified nutritionist, certified
S. 6263 3
dietitian or registered dietitian upon the referral of a physician or
other licensed health care provider legally authorized to prescribe
under title eight of the education law. Education provided by the certi-
fied diabetes nurse educator, certified nutritionist, certified dieti-
tian or registered dietitian may be limited to group settings wherever
practicable. Coverage for self-management education and education
relating to diet shall also include home visits when medically neces-
sary.
(B) Such coverage may be subject to annual deductibles and coinsurance
as may be deemed appropriate by the superintendent and as are consistent
with those established for other benefits within a given policy;
PROVIDED, HOWEVER, THAT A COVERED PERSON SHALL NOT BE REQUIRED TO PAY AN
AMOUNT IN EXCESS OF ONE HUNDRED DOLLARS PER THIRTY DAY SUPPLY OF
PRESCRIPTION INSULIN REGARDLESS OF THE AMOUNT OR TYPE OF INSULIN NEEDED
TO FILL THE COVERED PERSON'S PRESCRIPTION, HOWEVER NOTHING SHALL PREVENT
AN INSURER FROM REDUCING SUCH MAXIMUM AMOUNT.
(C) This paragraph shall not apply to a policy which covers persons
employed in more than one state or the benefit structure of which was
the subject of collective bargaining affecting persons employed in more
than one state unless such policy is issued under the New York state
health insurance plan established under article eleven of the civil
service law or issued to or through a local government.
§ 3. Subsection (u) of section 4303 of the insurance law, as amended
by chapter 338 of the laws of 2003, is amended to read as follows:
(u) (1) A medical expense indemnity corporation or a health service
corporation 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
include coverage for the following equipment and supplies for the treat-
ment of diabetes, if recommended or prescribed by a physician or other
licensed health care provider legally authorized to prescribe under
title eight of the education law: blood glucose monitors and blood
glucose monitors for the visually impaired, data management systems,
test strips for glucose monitors and visual reading and urine testing
strips, insulin, injection aids, cartridges for the visually impaired,
syringes, insulin pumps and appurtenances thereto, insulin infusion
devices, and oral agents for controlling blood sugar. In addition, the
commissioner of the department of health shall provide and periodically
update by rule or regulation a list of additional diabetes equipment and
related supplies such as are medically necessary for the treatment of
diabetes, for which there shall also be coverage. Such policies shall
also include coverage for diabetes self-management education to ensure
that persons with diabetes are educated as to the proper self-management
and treatment of their diabetic condition, including information on
proper diets. Such coverage for self-management education and education
relating to diet shall be limited to visits medically necessary upon the
diagnosis of diabetes, where a physician diagnoses a significant change
in the patient's symptoms or conditions which necessitate changes in a
patient's self-management, or where reeducation or refresher education
is necessary. Such education may be provided by the physician or other
licensed health care provider legally authorized to prescribe under
title eight of the education law, or their staff, as part of an office
visit for diabetes diagnosis or treatment, or by a certified diabetes
nurse educator, certified nutritionist, certified dietitian or regis-
tered dietitian upon the referral of a physician or other licensed
health care provider legally authorized to prescribe under title eight
S. 6263 4
of the education law. Education provided by the certified diabetes nurse
educator, certified nutritionist, certified dietitian or registered
dietitian may be limited to group settings wherever practicable. Cover-
age for self-management education and education relating to diet shall
also include home visits when medically necessary.
(2) Such coverage may be subject to annual deductibles and coinsurance
as may be deemed appropriate by the superintendent and as are consistent
with those established for other benefits within a given policy;
PROVIDED, HOWEVER, THAT A COVERED PERSON SHALL NOT BE REQUIRED TO PAY AN
AMOUNT IN EXCESS OF ONE HUNDRED DOLLARS PER THIRTY DAY SUPPLY OF
PRESCRIPTION INSULIN REGARDLESS OF THE AMOUNT OR TYPE OF INSULIN NEEDED
TO FILL THE COVERED PERSON'S PRESCRIPTION, HOWEVER NOTHING SHALL PREVENT
AN INSURER FROM REDUCING SUCH MAXIMUM AMOUNT.
(3) This subsection shall not apply to a policy which covers persons
employed in more than one state or the benefit structure of which was
the subject of collective bargaining affecting persons employed in more
than one state unless such policy is issued under the New York state
health insurance plan established under article eleven of the civil
service law or issued to or through a local government.
§ 4. This act shall take effect January 1, 2020 and shall apply to all
policies and contracts issued, renewed, modified, altered or amended on
or after such date.