S T A T E O F N E W Y O R K
________________________________________________________________________
8001
2023-2024 Regular Sessions
I N A S S E M B L Y
September 1, 2023
___________
Introduced by M. of A. L. ROSENTHAL -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law, in relation to requiring health
insurance plans to provide coverage for epinephrine auto-injector
devices and capping the co-pay or deductible for such epinephrine
auto-injector devices at sixty dollars
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 39 to read as follows:
(39) (A) EVERY INSURER ISSUING A POLICY OF ACCIDENT AND HEALTH INSUR-
ANCE 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 INCLUDE COVERAGE FOR MEDICALLY
NECESSARY EPINEPHRINE AUTO-INJECTOR DEVICES FOR THE EMERGENCY TREATMENT
OF LIFE-THREATENING ALLERGIC REACTIONS.
(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, THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED TO
PAY OUT-OF-POCKET FOR TWO EPINEPHRINE AUTO-INJECTOR DEVICES SHALL BE
CAPPED AT AN AMOUNT NOT TO EXCEED SIXTY DOLLARS PER THIRTY-DAY SUPPLY,
REGARDLESS OF THE INSURED'S DEDUCTIBLE, COPAYMENT, COINSURANCE OR ANY
OTHER COST SHARING REQUIREMENT.
(C) NOTHING IN THIS SECTION SHALL PREVENT AN INSURER FROM REDUCING A
COVERED PERSON'S COST SHARING TO AN AMOUNT THAT IS LOWER THAN THE AMOUNT
SPECIFIED IN SUBPARAGRAPH (B) OF THIS PARAGRAPH.
(D) FOR THE PURPOSES OF THIS PARAGRAPH, "EPINEPHRINE AUTO-INJECTOR
DEVICE" SHALL HAVE THE SAME MEANING AS PROVIDED IN PARAGRAPH (B) OF
SUBDIVISION ONE OF SECTION THREE THOUSAND-C OF THE PUBLIC HEALTH LAW.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD13118-01-3
A. 8001 2
§ 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 23 to read as follows:
(23) (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 MEDICALLY NECESSARY
EPINEPHRINE AUTO-INJECTOR DEVICES FOR THE EMERGENCY TREATMENT OF LIFE-
THREATENING ALLERGIC REACTIONS.
(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, THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED TO
PAY OUT-OF-POCKET FOR TWO EPINEPHRINE AUTO-INJECTOR DEVICES SHALL BE
CAPPED AT AN AMOUNT NOT TO EXCEED SIXTY DOLLARS PER THIRTY-DAY SUPPLY,
REGARDLESS OF THE INSURED'S DEDUCTIBLE, COPAYMENT, COINSURANCE OR ANY
OTHER COST SHARING REQUIREMENT.
(C) NOTHING IN THIS SECTION SHALL PREVENT AN INSURER FROM REDUCING A
COVERED PERSON'S COST SHARING TO AN AMOUNT THAT IS LOWER THAN THE AMOUNT
SPECIFIED IN SUBPARAGRAPH (B) OF THIS PARAGRAPH.
(D) FOR THE PURPOSES OF THIS PARAGRAPH, "EPINEPHRINE AUTO-INJECTOR
DEVICE" SHALL HAVE THE SAME MEANING AS PROVIDED IN PARAGRAPH (B) OF
SUBDIVISION ONE OF SECTION THREE THOUSAND-C OF THE PUBLIC HEALTH LAW.
§ 3. Section 4303 of the insurance law is amended by adding a new
subsection (vv) to read as follows:
(VV) (1) EVERY MEDICAL EXPENSE INDEMNITY CORPORATION, HOSPITAL SERVICE
CORPORATION AND HEALTH SERVICE CORPORATION WHICH PROVIDES MEDICAL COVER-
AGE 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 MEDICALLY NECESSARY
EPINEPHRINE AUTO-INJECTOR DEVICES FOR THE EMERGENCY TREATMENT OF LIFE-
THREATENING ALLERGIC REACTIONS.
(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, THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED TO
PAY OUT-OF-POCKET FOR TWO EPINEPHRINE AUTO-INJECTOR DEVICES SHALL BE
CAPPED AT AN AMOUNT NOT TO EXCEED SIXTY DOLLARS PER THIRTY-DAY SUPPLY,
REGARDLESS OF THE INSURED'S DEDUCTIBLE, COPAYMENT, COINSURANCE OR ANY
OTHER COST SHARING REQUIREMENT.
(3) NOTHING IN THIS SECTION SHALL PREVENT AN INSURER FROM REDUCING A
COVERED PERSON'S COST SHARING TO AN AMOUNT THAT IS LOWER THAN THE AMOUNT
SPECIFIED IN PARAGRAPH TWO OF THIS SUBSECTION.
(4) FOR THE PURPOSES OF THIS SUBSECTION, "EPINEPHRINE AUTO-INJECTOR
DEVICE" SHALL HAVE THE SAME MEANING AS PROVIDED IN PARAGRAPH (B) OF
SUBDIVISION ONE OF SECTION THREE THOUSAND-C OF THE PUBLIC HEALTH LAW.
§ 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. Effective immediately, the addition, amendment
and/or repeal of any rule or regulation necessary for the implementation
of this act on its effective date are authorized to be made and
completed on or before such effective date.