S T A T E O F N E W Y O R K
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11517
I N A S S E M B L Y
May 28, 2026
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Introduced by COMMITTEE ON RULES -- (at request of M. of A. Lavine) --
read once and referred to the Committee on Insurance
AN ACT to amend the insurance law and the social services law, in
relation to insurance coverage for bruxism diagnosis and treatment
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Legislative findings. The legislature hereby finds and
declares that Bruxism is a serious oral health condition that may result
in tooth fracture, enamel erosion, temporomandibular joint disorders,
chronic pain, sleep disruption, and irreversible tooth loss when left
untreated. Early diagnosis and preventative treatment of bruxism
substantially reduces the need for costly restorative dental procedures,
including crowns, implants, dentures, and oral surgery. Current dental
reimbursement practices frequently fail to adequately compensate
dentists for the evaluation, diagnosis, and treatment planning associ-
ated with bruxism and related occlusal disorders, thereby discouraging
preventative intervention. Many dental insurance policies nominally
provide coverage for occlusal guards while imposing reimbursement limi-
tations, utilization barriers, or medical necessity requirements that
render such coverage inaccessible in practice. Low-income individuals,
Medicaid recipients, individuals with disabilities, and underserved
minority communities disproportionately experience barriers to preventa-
tive oral healthcare and are more likely to suffer preventable dental
deterioration and tooth loss due to untreated bruxism. It is therefore
in the public interest to promote preventative oral healthcare by
requiring meaningful reimbursement and coverage for the diagnosis and
treatment of bruxism and related occlusal disorders.
§ 2. Subsection (i) of section 3216 of the insurance law is amended by
adding a new paragraph 42 to read as follows:
(42) (A) EVERY POLICY WHICH PROVIDES COVERAGE OR REIMBURSEMENT FOR
DENTAL SERVICES SHALL PROVIDE COVERAGE OR REIMBURSEMENT FOR THE DIAGNO-
SIS AND TREATMENT OF BRUXISM AND RELATED OCCLUSAL DISORDERS WHEN DETER-
MINED TO BE MEDICALLY NECESSARY BY A LICENSED DENTIST.
(B) SUCH COVERAGE SHALL INCLUDE REIMBURSEMENT FOR:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD15988-01-6
A. 11517 2
(I) CLINICAL EVALUATION AND SCREENING;
(II) DIAGNOSIS;
(III) TREATMENT PLANNING;
(IV) FOLLOW-UP MONITORING; AND
(V) CUSTOM-FABRICATED OCCLUSAL GUARDS OR APPLIANCES PRESCRIBED FOR THE
TREATMENT OF DIAGNOSED BRUXISM OR RELATED OCCLUSAL DISORDERS.
(C) NO INSURER SHALL DENY COVERAGE FOR A PRESCRIBED OCCLUSAL GUARD
SOLELY ON THE BASIS THAT THE TREATMENT IS PREVENTATIVE IN NATURE.
(D) COVERAGE PROVIDED PURSUANT TO THIS PARAGRAPH SHALL NOT BE SUBJECT
TO ANNUAL OR LIFETIME LIMITATIONS THAT ARE LESS FAVORABLE THAN THOSE
IMPOSED ON OTHER MEDICALLY NECESSARY DENTAL SERVICES.
(E) THE SUPERINTENDENT OF FINANCIAL SERVICES MAY PROMULGATE RULES AND
REGULATIONS NECESSARY TO IMPLEMENT THE PROVISIONS OF THIS PARAGRAPH,
INCLUDING STANDARDS RELATING TO MEDICAL NECESSITY AND UTILIZATION
REVIEW.
§ 3. Subsection (l) of section 3221 of the insurance law is amended by
adding a new paragraph 24 to read as follows:
(24) (A) EVERY GROUP OR BLANKET ACCIDENT AND HEALTH INSURANCE POLICY
ISSUED OR ISSUED FOR DELIVERY IN THIS STATE WHICH PROVIDES COVERAGE OR
REIMBURSEMENT FOR DENTAL SERVICES SHALL PROVIDE COVERAGE OR REIMBURSE-
MENT FOR THE DIAGNOSIS AND TREATMENT OF BRUXISM AND RELATED OCCLUSAL
DISORDERS WHEN DETERMINED TO BE MEDICALLY NECESSARY BY A LICENSED
DENTIST.
(B) SUCH COVERAGE SHALL INCLUDE REIMBURSEMENT FOR:
(I) CLINICAL EVALUATION AND SCREENING;
(II) DIAGNOSIS;
(III) TREATMENT PLANNING;
(IV) FOLLOW-UP MONITORING; AND
(V) CUSTOM-FABRICATED OCCLUSAL GUARDS OR APPLIANCES PRESCRIBED FOR THE
TREATMENT OF DIAGNOSED BRUXISM OR RELATED OCCLUSAL DISORDERS.
(C) NO INSURER SHALL DENY COVERAGE FOR A PRESCRIBED OCCLUSAL GUARD
SOLELY ON THE BASIS THAT THE TREATMENT IS PREVENTATIVE IN NATURE.
(D) COVERAGE PROVIDED PURSUANT TO THIS PARAGRAPH SHALL NOT BE SUBJECT
TO ANNUAL OR LIFETIME LIMITATIONS THAT ARE LESS FAVORABLE THAN THOSE
IMPOSED ON OTHER MEDICALLY NECESSARY DENTAL SERVICES.
(E) THE SUPERINTENDENT OF FINANCIAL SERVICES MAY PROMULGATE RULES AND
REGULATIONS NECESSARY TO IMPLEMENT THE PROVISIONS OF THIS PARAGRAPH,
INCLUDING STANDARDS RELATING TO MEDICAL NECESSITY AND UTILIZATION
REVIEW.
§ 4. Section 4303 of the insurance law is amended by adding a new
subsection (yy) to read as follows:
(YY) (1) EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPO-
RATION, A HOSPITAL SERVICE CORPORATION OR A HEALTH SERVICE CORPORATION
WHICH PROVIDES COVERAGE OR REIMBURSEMENT FOR DENTAL SERVICES SHALL
PROVIDE COVERAGE OR REIMBURSEMENT FOR THE DIAGNOSIS AND TREATMENT OF
BRUXISM AND RELATED OCCLUSAL DISORDERS WHEN DETERMINED TO BE MEDICALLY
NECESSARY BY A LICENSED DENTIST.
(2) SUCH COVERAGE SHALL INCLUDE REIMBURSEMENT FOR:
(A) CLINICAL EVALUATION AND SCREENING;
(B) DIAGNOSIS;
(C) TREATMENT PLANNING;
(D) FOLLOW-UP MONITORING; AND
(E) CUSTOM-FABRICATED OCCLUSAL GUARDS OR APPLIANCES PRESCRIBED FOR THE
TREATMENT OF DIAGNOSED BRUXISM OR RELATED OCCLUSAL DISORDERS.
(3) NO INSURER SHALL DENY COVERAGE FOR A PRESCRIBED OCCLUSAL GUARD
SOLELY ON THE BASIS THAT THE TREATMENT IS PREVENTATIVE IN NATURE.
A. 11517 3
(4) COVERAGE PROVIDED PURSUANT TO THIS PARAGRAPH SHALL NOT BE SUBJECT
TO ANNUAL OR LIFETIME LIMITATIONS THAT ARE LESS FAVORABLE THAN THOSE
IMPOSED ON OTHER MEDICALLY NECESSARY DENTAL SERVICES.
(5) THE SUPERINTENDENT OF FINANCIAL SERVICES MAY PROMULGATE RULES AND
REGULATIONS NECESSARY TO IMPLEMENT THE PROVISIONS OF THIS PARAGRAPH,
INCLUDING STANDARDS RELATING TO MEDICAL NECESSITY AND UTILIZATION
REVIEW.
§ 5. Subdivision 2 of section 365-a of the social services law is
amended by adding a new paragraph (f-1) to read as follows:
(F-1) (I) CARE AND SERVICES FOR THE DIAGNOSIS AND TREATMENT OF BRUXISM
AND RELATED OCCLUSAL DISORDERS WHEN DETERMINED TO BE MEDICALLY NECESSARY
BY A LICENSED DENTIST.
(II) SUCH COVERAGE SHALL INCLUDE REIMBURSEMENT FOR:
(A) CLINICAL EVALUATION AND SCREENING;
(B) DIAGNOSIS;
(C) TREATMENT PLANNING;
(D) FOLLOW-UP MONITORING; AND
(E) CUSTOM-FABRICATED OCCLUSAL GUARDS OR APPLIANCES PRESCRIBED FOR THE
TREATMENT OF DIAGNOSED BRUXISM OR RELATED OCCLUSAL DISORDERS.
(III) THE COMMISSIONER MAY PROMULGATE RULES AND REGULATIONS NECESSARY
TO IMPLEMENT THE PROVISIONS OF THIS PARAGRAPH, INCLUDING STANDARDS
RELATING TO MEDICAL NECESSITY AND UTILIZATION REVIEW. IN PROMULGATING
SUCH REGULATIONS, THE COMMISSIONER SHALL PRIORITIZE ACCESS TO PREVENTA-
TIVE TREATMENT FOR:
(A) LOW-INCOME INDIVIDUALS;
(B) INDIVIDUALS WITH DEVELOPMENTAL OR INTELLECTUAL DISABILITIES;
(C) INDIVIDUALS WITH NEUROLOGICAL CONDITIONS ASSOCIATED WITH BRUXISM;
AND
(D) COMMUNITIES EXPERIENCING SIGNIFICANT ORAL HEALTH DISPARITIES;
§ 6. 1. The department of health and department of financial services
shall study the impact of expanded bruxism diagnosis and treatment
coverage on:
a. preventative dental outcomes,
b. tooth loss prevention,
c. utilization of restorative dental procedures,
d. and oral health disparities.
2. The report required by this section shall be submitted to the
governor and legislature within three years of the effective date of
this act.
§ 7. This act shall take effect on the one hundred eightieth day after
it shall have become a law and shall apply to policies and contracts
issued, renewed, modified, altered or amended on or after such effective
date.