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.