Assembly Bill A3687A

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3687
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 30, 2025
                                ___________
 
 Introduced  by  M. of A. WEPRIN, HEVESI, DAVILA, PAULIN, BROOK-KRASNY --
   read once and referred to the Committee on Insurance
 
 AN ACT to amend the insurance law, in relation to addressing non-covered
   dental services
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1.  Section  4224 of the insurance law is amended by adding a
 new subsection (g) to read as follows:
   (G)(1) NOTWITHSTANDING ANY OTHER PROVISION OF THIS SECTION, NO INSURER
 AUTHORIZED TO DO BUSINESS IN THIS STATE SHALL INCLUDE A PROVISION  IN  A
 CONTRACT  OR  PARTICIPATING  PROVIDER  AGREEMENT  WITH  A  DENTIST WHICH
 REQUIRES, DIRECTLY OR INDIRECTLY, THAT A PARTICIPATING  DENTIST  PROVIDE
 SERVICES  TO  AN  INSURED  AT  A  FEE SET BY, OR AT A FEE SUBJECT TO THE
 APPROVAL OF, THE INSURER UNLESS THE DENTAL SERVICES ARE COVERED SERVICES
 UNDER THE INSURED'S DENTAL PLAN.
   (2) FOR PURPOSES OF THIS SUBSECTION,  "COVERED  SERVICES"  SHALL  MEAN
 DENTAL  SERVICES FOR WHICH REIMBURSEMENT IS AVAILABLE UNDER AN INSURED'S
 DENTAL PLAN OR FOR WHICH A REIMBURSEMENT WOULD BE AVAILABLE BUT FOR  THE
 APPLICATION  OF CONTRACTUAL LIMITATIONS SUCH AS DEDUCTIBLES, COPAYMENTS,
 COINSURANCE, WAITING PERIODS, ANNUAL  OR  LIFETIME  MAXIMUMS,  FREQUENCY
 LIMITATIONS, ALTERNATIVE BENEFIT PAYMENTS, OR ANY OTHER LIMITATION.
   §  2. Subsection (s) of section 4303 of the insurance law, as added by
 chapter 293 of the laws of 1992, is amended to read as follows:
   [(s)](S-1)(1) Notwithstanding any provision of a contract issued by  a
 medical expense indemnity corporation, a dental expense indemnity corpo-
 ration  or  health  service  corporation,  every contract which provides
 coverage for care provided through licensed health professionals who can
 bill for services shall provide the same coverage and reimbursement  for
 such  service  provided pursuant to a clinical practice plan established
 pursuant to subdivision fourteen of  section  two  hundred  six  of  the
 public health law.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07721-01-5
              

 A. 3687                             2
 
   (2)  NOTWITHSTANDING  ANY  OTHER PROVISION OF THIS SECTION, NO MEDICAL
 EXPENSE INDEMNITY CORPORATION, DENTAL EXPENSE INDEMNITY  CORPORATION  OR
 HEALTH SERVICE CORPORATION AUTHORIZED TO DO BUSINESS IN THIS STATE SHALL
 INCLUDE  A  PROVISION  IN A CONTRACT OR PARTICIPATING PROVIDER AGREEMENT
 WITH  A  DENTIST  WHICH REQUIRES, DIRECTLY OR INDIRECTLY, THAT A PARTIC-
 IPATING DENTIST PROVIDE SERVICES TO AN INSURED AT A FEE SET BY, OR AT  A
 FEE  SUBJECT  TO  THE APPROVAL OF, THE MEDICAL EXPENSE  INDEMNITY CORPO-
 RATION, DENTAL EXPENSE INDEMNITY CORPORATION OR  HEALTH  SERVICE  CORPO-
 RATION  UNLESS  THE  DENTAL  SERVICES  ARE  COVERED  SERVICES  UNDER THE
 INSURED'S DENTAL PLAN.
   (3) FOR PURPOSES OF THIS SUBSECTION,  "COVERED  SERVICES"  SHALL  MEAN
 DENTAL  SERVICES FOR WHICH REIMBURSEMENT IS AVAILABLE UNDER AN INSURED'S
 DENTAL PLAN OR FOR WHICH A REIMBURSEMENT WOULD BE AVAILABLE BUT FOR  THE
 APPLICATION  OF CONTRACTUAL LIMITATIONS SUCH AS DEDUCTIBLES, COPAYMENTS,
 COINSURANCE, WAITING PERIODS, ANNUAL  OR  LIFETIME  MAXIMUMS,  FREQUENCY
 LIMITATIONS, ALTERNATIVE BENEFIT PAYMENTS, OR ANY OTHER LIMITATION.
   § 3. This act shall take effect January 1, 2027 and shall apply to all
 insurance contracts issued or entered into on or after such date.

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  3687--B
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 30, 2025
                                ___________
 
 Introduced  by  M. of A. WEPRIN, HEVESI, DAVILA, PAULIN, BROOK-KRASNY --
   read once and referred to the  Committee  on  Insurance  --  committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to  said  committee  -- again reported from said committee with amend-
   ments, ordered reprinted as amended and recommitted to said committee

 AN ACT to amend the insurance law, in relation to addressing non-covered
   dental services
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Subsection  (c)  of  section 3216 of the insurance law is
 amended by adding a new paragraph 16 to read as follows:
   (16) (A) ALL POLICIES PROVIDING COVERAGE  OF  DENTAL  SERVICES  ISSUED
 PURSUANT TO THIS SECTION SHALL INCLUDE THE FOLLOWING DISCLOSURE: "IMPOR-
 TANT: IF YOU OPT TO RECEIVE SERVICES THAT ARE NOT COVERED SERVICES UNDER
 THIS PLAN, A PARTICIPATING PROVIDER MAY CHARGE THEIR NORMAL FEE FOR SUCH
 SERVICES.  PRIOR  TO PROVIDING YOU WITH SERVICES THAT ARE NOT COVERED, A
 PROVIDER WILL PROVIDE AN ESTIMATED COST FOR EACH SERVICE."
   (B) FOR PURPOSES OF THIS  PARAGRAPH,  "COVERED  SERVICES"  SHALL  MEAN
 DENTAL  SERVICES FOR WHICH REIMBURSEMENT IS AVAILABLE UNDER AN INSURED'S
 DENTAL PLAN OR FOR WHICH A REIMBURSEMENT WOULD BE AVAILABLE BUT FOR  THE
 APPLICATION  OF CONTRACTUAL LIMITATIONS SUCH AS DEDUCTIBLES, COPAYMENTS,
 COINSURANCE, WAITING PERIODS, ANNUAL  OR  LIFETIME  MAXIMUMS,  FREQUENCY
 LIMITATIONS, ALTERNATIVE BENEFIT PAYMENTS, OR ANY OTHER LIMITATION.
   § 2. Subsection (a) of section 3221 of the insurance law is amended by
 adding a new paragraph 18 to read as follows:
   (18)  (A)  ALL  POLICIES  PROVIDING COVERAGE OF DENTAL SERVICES ISSUED
 PURSUANT  TO  THIS  SECTION  SHALL  INCLUDE  THE  FOLLOWING  DISCLOSURE:
 "IMPORTANT: IF YOU OPT TO RECEIVE SERVICES THAT ARE NOT COVERED SERVICES
 UNDER  THIS  PLAN,  A PARTICIPATING PROVIDER MAY CHARGE THEIR NORMAL FEE
 FOR SUCH SERVICES. PRIOR TO PROVIDING YOU WITH  SERVICES  THAT  ARE  NOT
 COVERED, A PROVIDER WILL PROVIDE AN ESTIMATED COST FOR EACH SERVICE."
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07721-04-5
              

 A. 3687--B                          2
 
   (B)  FOR THE PURPOSES OF THIS PARAGRAPH, "COVERED SERVICES" SHALL MEAN
 DENTAL SERVICES FOR WHICH REIMBURSEMENT IS AVAILABLE UNDER AN  INSURED'S
 DENTAL  PLAN OR FOR WHICH A REIMBURSEMENT WOULD BE AVAILABLE BUT FOR THE
 APPLICATION OF CONTRACTUAL LIMITATIONS SUCH AS DEDUCTIBLES,  COPAYMENTS,
 COINSURANCE,  WAITING  PERIODS,  ANNUAL  OR LIFETIME MAXIMUMS, FREQUENCY
 LIMITATIONS, ALTERNATIVE BENEFIT PAYMENTS, OR ANY OTHER LIMITATION.
   § 3. Subsection (s) of section 4303 of the insurance law, as added  by
 chapter 293 of the laws of 1992, is amended to read as follows:
   [(s)](S-1)(1)  Notwithstanding any provision of a contract issued by a
 medical expense indemnity corporation, a dental expense indemnity corpo-
 ration or health service  corporation,  every  contract  which  provides
 coverage for care provided through licensed health professionals who can
 bill  for services shall provide the same coverage and reimbursement for
 such service provided pursuant to a clinical practice  plan  established
 pursuant  to  subdivision  fourteen  of  section  two hundred six of the
 public health law.
   (2) ALL CONTRACTS FOR DENTAL SERVICES ISSUED PURSUANT TO THIS  SECTION
 SHALL  INCLUDE  THE  FOLLOWING  DISCLOSURE:  "IMPORTANT:  IF  YOU OPT TO
 RECEIVE SERVICES THAT ARE  NOT  COVERED  SERVICES  UNDER  THIS  PLAN,  A
 PARTICIPATING  PROVIDER  MAY  CHARGE THEIR NORMAL FEE FOR SUCH SERVICES.
 PRIOR TO PROVIDING YOU WITH SERVICES THAT ARE NOT  COVERED,  A  PROVIDER
 WILL PROVIDE AN ESTIMATED COST FOR EACH SERVICE."
   (3)  FOR  PURPOSES  OF  THIS SUBSECTION, "COVERED SERVICES" SHALL MEAN
 DENTAL SERVICES FOR WHICH REIMBURSEMENT IS AVAILABLE UNDER AN  INSURED'S
 DENTAL  PLAN OR FOR WHICH A REIMBURSEMENT WOULD BE AVAILABLE BUT FOR THE
 APPLICATION OF CONTRACTUAL LIMITATIONS SUCH AS DEDUCTIBLES,  COPAYMENTS,
 COINSURANCE,  WAITING  PERIODS,  ANNUAL  OR LIFETIME MAXIMUMS, FREQUENCY
 LIMITATIONS, ALTERNATIVE BENEFIT PAYMENTS, OR ANY OTHER LIMITATION.
   § 4. This act shall take effect January 1, 2027 and shall apply to all
 insurance contracts issued or entered into on or after such date.