S T A T E O F N E W Y O R K
________________________________________________________________________
11520
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, in relation to insurance coverage for
endodontic services
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 42 to read as follows:
(42) (A) EVERY POLICY WHICH PROVIDES COVERAGE OR REIMBURSEMENT FOR
DENTAL SERVICES WHICH INCLUDES COVERAGE FOR RESTORATIVE DENTAL SERVICES
SHALL PROVIDE COVERAGE FOR MEDICALLY NECESSARY ENDODONTIC SERVICES
PERFORMED BY A LICENSED DENTIST ACTING WITHIN THE LAWFUL SCOPE OF PRAC-
TICE, INCLUDING A LICENSED ENDODONTIST.
(B) SUCH COVERAGE SHALL INCLUDE, BUT NOT BE LIMITED TO:
(I) DIAGNOSTIC EXAMINATIONS AND EVALUATIONS;
(II) SPECIALIST CONSULTATIONS;
(III) RADIOGRAPHIC AND DIAGNOSTIC IMAGING;
(IV) ROOT CANAL THERAPY;
(V) ENDODONTIC RETREATMENT PROCEDURES;
(VI) APICOECTOMY PROCEDURES;
(VII) EMERGENCY ENDODONTIC TREATMENT; AND
(VIII) POST-TREATMENT CARE REASONABLY RELATED TO ENDODONTIC TREATMENT.
(C) AN INSURER SHALL NOT DENY COVERAGE FOR A MEDICALLY NECESSARY
COVERED SERVICE SOLELY BECAUSE SUCH SERVICE IS RENDERED BY A LICENSED
ENDODONTIST RATHER THAN A GENERAL DENTIST.
(D) IF AN INSURER DOES NOT MAINTAIN AN ADEQUATE NETWORK OF PARTICIPAT-
ING ENDODONTISTS TO ENSURE REASONABLE ACCESS TO COVERED ENDODONTIC
SERVICES WITHOUT UNREASONABLE DELAY, THE INSURER SHALL PROVIDE COVERAGE
FOR SERVICES RENDERED BY A NON-PARTICIPATING ENDODONTIST AT NO GREATER
COST-SHARING OBLIGATION THAN WOULD APPLY TO SERVICES RENDERED BY A
PARTICIPATING PROVIDER.
(E) NO POLICY SUBJECT TO THIS PARAGRAPH SHALL IMPOSE ANNUAL LIMITA-
TIONS, FREQUENCY LIMITATIONS, OR UTILIZATION REVIEW REQUIREMENTS FOR
MEDICALLY NECESSARY ENDODONTIC SERVICES THAT ARE MORE RESTRICTIVE THAN
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD15989-01-6
A. 11520 2
THOSE APPLIED TO OTHER COMPARABLE RESTORATIVE DENTAL SERVICES COVERED
UNDER THE POLICY.
(F) FOR PURPOSES OF THIS PARAGRAPH, "MEDICALLY NECESSARY ENDODONTIC
SERVICES" MEANS DENTAL SERVICES NECESSARY TO DIAGNOSE, TREAT, RELIEVE,
OR PREVENT INFECTION, PAIN, DISEASE, OR DAMAGE AFFECTING THE DENTAL PULP
OR SURROUNDING TISSUES, CONSISTENT WITH GENERALLY ACCEPTED STANDARDS OF
DENTAL PRACTICE.
§ 2. 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 POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS
STATE WHICH PROVIDES COVERAGE OR REIMBURSEMENT FOR DENTAL SERVICES WHICH
INCLUDES COVERAGE FOR RESTORATIVE DENTAL SERVICES SHALL PROVIDE COVERAGE
FOR MEDICALLY NECESSARY ENDODONTIC SERVICES PERFORMED BY A LICENSED
DENTIST ACTING WITHIN THE LAWFUL SCOPE OF PRACTICE, INCLUDING A LICENSED
ENDODONTIST.
(B) SUCH COVERAGE SHALL INCLUDE, BUT NOT BE LIMITED TO:
(I) DIAGNOSTIC EXAMINATIONS AND EVALUATIONS;
(II) SPECIALIST CONSULTATIONS;
(III) RADIOGRAPHIC AND DIAGNOSTIC IMAGING;
(IV) ROOT CANAL THERAPY;
(V) ENDODONTIC RETREATMENT PROCEDURES;
(VI) APICOECTOMY PROCEDURES;
(VII) EMERGENCY ENDODONTIC TREATMENT; AND
(VIII) POST-TREATMENT CARE REASONABLY RELATED TO ENDODONTIC TREATMENT.
(C) AN INSURER SHALL NOT DENY COVERAGE FOR A MEDICALLY NECESSARY
COVERED SERVICE UNDER THIS PARAGRAPH SOLELY BECAUSE SUCH SERVICE IS
RENDERED BY A LICENSED ENDODONTIST RATHER THAN A GENERAL DENTIST.
(D) IF AN INSURER DOES NOT MAINTAIN AN ADEQUATE NETWORK OF PARTICIPAT-
ING ENDODONTISTS TO ENSURE REASONABLE ACCESS TO COVERED ENDODONTIC
SERVICES WITHOUT UNREASONABLE DELAY, THE INSURER SHALL PROVIDE COVERAGE
FOR SERVICES RENDERED BY A NON-PARTICIPATING ENDODONTIST AT NO GREATER
COST-SHARING OBLIGATION THAN WOULD APPLY TO SERVICES RENDERED BY A
PARTICIPATING PROVIDER.
(E) NO POLICY SUBJECT TO THIS PARAGRAPH SHALL IMPOSE ANNUAL LIMITA-
TIONS, FREQUENCY LIMITATIONS, OR UTILIZATION REVIEW REQUIREMENTS FOR
MEDICALLY NECESSARY ENDODONTIC SERVICES THAT ARE MORE RESTRICTIVE THAN
THOSE APPLIED TO OTHER COMPARABLE RESTORATIVE DENTAL SERVICES COVERED
UNDER THE POLICY.
(F) FOR PURPOSES OF THIS PARAGRAPH, "MEDICALLY NECESSARY ENDODONTIC
SERVICES" MEANS DENTAL SERVICES NECESSARY TO DIAGNOSE, TREAT, RELIEVE,
OR PREVENT INFECTION, PAIN, DISEASE, OR DAMAGE AFFECTING THE DENTAL PULP
OR SURROUNDING TISSUES, CONSISTENT WITH GENERALLY ACCEPTED STANDARDS OF
DENTAL PRACTICE.
§ 3. 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 WHICH
INCLUDES COVERAGE FOR RESTORATIVE DENTAL SERVICES SHALL PROVIDE COVERAGE
FOR MEDICALLY NECESSARY ENDODONTIC SERVICES PERFORMED BY A LICENSED
DENTIST ACTING WITHIN THE LAWFUL SCOPE OF PRACTICE, INCLUDING A LICENSED
ENDODONTIST.
(2) SUCH COVERAGE SHALL INCLUDE, BUT NOT BE LIMITED TO:
(A) DIAGNOSTIC EXAMINATIONS AND EVALUATIONS;
(B) SPECIALIST CONSULTATIONS;
(C) RADIOGRAPHIC AND DIAGNOSTIC IMAGING;
(D) ROOT CANAL THERAPY;
A. 11520 3
(E) ENDODONTIC RETREATMENT PROCEDURES;
(F) APICOECTOMY PROCEDURES;
(G) EMERGENCY ENDODONTIC TREATMENT; AND
(H) POST-TREATMENT CARE REASONABLY RELATED TO ENDODONTIC TREATMENT.
(3) AN INSURER SHALL NOT DENY COVERAGE FOR A MEDICALLY NECESSARY
COVERED SERVICE UNDER THIS SUBSECTION SOLELY BECAUSE SUCH SERVICE IS
RENDERED BY A LICENSED ENDODONTIST RATHER THAN A GENERAL DENTIST.
(4) IF AN INSURER DOES NOT MAINTAIN AN ADEQUATE NETWORK OF PARTICIPAT-
ING ENDODONTISTS TO ENSURE REASONABLE ACCESS TO COVERED ENDODONTIC
SERVICES WITHOUT UNREASONABLE DELAY, THE INSURER SHALL PROVIDE COVERAGE
FOR SERVICES RENDERED BY A NON-PARTICIPATING ENDODONTIST AT NO GREATER
COST-SHARING OBLIGATION THAN WOULD APPLY TO SERVICES RENDERED BY A
PARTICIPATING PROVIDER.
(5) NO POLICY SUBJECT TO THIS SUBSECTION SHALL IMPOSE ANNUAL LIMITA-
TIONS, FREQUENCY LIMITATIONS, OR UTILIZATION REVIEW REQUIREMENTS FOR
MEDICALLY NECESSARY ENDODONTIC SERVICES THAT ARE MORE RESTRICTIVE THAN
THOSE APPLIED TO OTHER COMPARABLE RESTORATIVE DENTAL SERVICES COVERED
UNDER THE POLICY.
(6) FOR PURPOSES OF THIS SUBSECTION, "MEDICALLY NECESSARY ENDODONTIC
SERVICES" MEANS DENTAL SERVICES NECESSARY TO DIAGNOSE, TREAT, RELIEVE,
OR PREVENT INFECTION, PAIN, DISEASE, OR DAMAGE AFFECTING THE DENTAL PULP
OR SURROUNDING TISSUES, CONSISTENT WITH GENERALLY ACCEPTED STANDARDS OF
DENTAL PRACTICE.
§ 4. The superintendent of financial services may promulgate any rules
and regulations necessary to implement the provisions of this act,
including standards relating to network adequacy for endodontic provid-
ers.
§ 5. This act shall take effect on the one hundred eightieth day after
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.