Assembly Bill A3687B

                             
                     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--A
 
                        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
 
 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)  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."
   (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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07721-02-5
 A. 3687--A                          2
              

 
 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.
   § 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.