Assembly Bill A5444A

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5444
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 14, 2025
                                ___________
 
 Introduced  by  M.  of  A.  ROSENTHAL  --  read once and referred to the
   Committee on Insurance
 
 AN ACT to amend the insurance law, in relation to coverage for perimeno-
   pausal and menopausal care and treatment
 
   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 40 to read as follows:
   (40) (A) EVERY POLICY THAT PROVIDES COVERAGE FOR HOSPITAL, SURGICAL OR
 MEDICAL CARE SHALL PROVIDE COVERAGE FOR  PERIMENOPAUSAL  AND  MENOPAUSAL
 CARE  AND TREATMENT ADMINISTERED BY A PHYSICIAN OR OTHER LICENSED HEALTH
 CARE PROVIDER. SYMPTOMS OF MENSTRUAL  COMPLICATIONS  FOR  PERIMENOPAUSAL
 AND MENOPAUSAL CARE AUTHORIZED UNDER THIS PARAGRAPH INCLUDE, BUT ARE NOT
 LIMITED  TO:  IRREGULAR  MENSTRUAL  PERIODS, HOT FLASHES, CHILLS, SLOWED
 METABOLISM, VAGINAL OR BLADDER PROBLEMS, DECREASE IN FERTILITY, LOSS  OF
 BONE,  INCREASE IN LOW-DENSITY LIPOPROTEIN CHOLESTEROL LEVELS, AND SLEEP
 DISRUPTION INCLUDING NIGHT SWEATS.
   (B) FOR PURPOSES OF SUBPARAGRAPH (A) OF THIS PARAGRAPH:
   (I) "MENOPAUSE" MEANS THE PERMANENT CESSATION OF MENSTRUATION  DUE  TO
 LOSS  OF  OVARIAN FOLLICULAR FUNCTION, WHERE OVARIES STOP RELEASING EGGS
 AND THE BODY PRODUCES LESS ESTROGEN AND PROGESTERONE.
   (II) "PERIMENOPAUSE" MEANS THE TRANSITION PERIOD IN WHICH A  WOMAN  IS
 NEAR THE END OF HER REPRODUCTIVE YEARS OR AT THE ONSET OF MENOPAUSE.
   (C)  SUCH COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS PARA-
 GRAPH 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.
   § 2. Subsection (k) of section 3221 of the insurance law is amended by
 adding a new paragraph 24 to read as follows:
   (24)(A) EVERY POLICY THAT PROVIDES COVERAGE FOR HOSPITAL, SURGICAL  OR
 MEDICAL  CARE  SHALL  PROVIDE COVERAGE FOR PERIMENOPAUSAL AND MENOPAUSAL
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD01048-01-5
              

 A. 5444                             2
 
 CARE OR TREATMENT ADMINISTERED BY A PHYSICIAN OR OTHER  LICENSED  HEALTH
 CARE  PROVIDER.  SYMPTOMS  OF MENSTRUAL COMPLICATIONS FOR PERIMENOPAUSAL
 AND MENOPAUSAL CARE AUTHORIZED UNDER THIS PARAGRAPH INCLUDE, BUT ARE NOT
 LIMITED  TO:  IRREGULAR  MENSTRUAL  PERIODS, HOT FLASHES, CHILLS, SLOWED
 METABOLISM, VAGINAL OR BLADDER PROBLEMS, DECREASE IN FERTILITY, LOSS  OF
 BONE,  INCREASE IN LOW-DENSITY LIPOPROTEIN CHOLESTEROL LEVELS, AND SLEEP
 DISRUPTION INCLUDING NIGHT SWEATS.
   (B) FOR PURPOSES OF SUBPARAGRAPH (A) OF THIS PARAGRAPH:
   (I) "MENOPAUSE" MEANS THE PERMANENT CESSATION OF MENSTRUATION  DUE  TO
 LOSS  OF  OVARIAN FOLLICULAR FUNCTION, WHERE OVARIES STOP RELEASING EGGS
 AND THE BODY PRODUCES LESS ESTROGEN AND PROGESTERONE.
   (II) "PERIMENOPAUSE" MEANS THE TRANSITION PERIOD IN WHICH A  WOMAN  IS
 NEAR THE END OF HER REPRODUCTIVE YEARS OR AT THE ONSET OF MENOPAUSE.
   (C)  SUCH COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS PARA-
 GRAPH 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.
   § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
 subsection (ww) to read as follows:
   (WW)(1)  ANY  CONTRACT  ISSUED  BY  A MEDICAL EXPENSE INDEMNITY CORPO-
 RATION, A HOSPITAL SERVICE CORPORATION OR A HEALTH SERVICES  CORPORATION
 THAT  PROVIDES  COVERAGE  FOR  HOSPITAL,  SURGICAL OR MEDICAL CARE SHALL
 PROVIDE COVERAGE FOR PERIMENOPAUSAL AND  MENOPAUSAL  CARE  OR  TREATMENT
 ADMINISTERED  BY  A  PHYSICIAN  OR  OTHER LICENSED HEALTH CARE PROVIDER.
 SYMPTOMS OF MENSTRUAL COMPLICATIONS FOR  PERIMENOPAUSAL  AND  MENOPAUSAL
 CARE  AUTHORIZED  UNDER  THIS PARAGRAPH INCLUDE, BUT ARE NOT LIMITED TO:
 IRREGULAR MENSTRUAL PERIODS, HOT  FLASHES,  CHILLS,  SLOWED  METABOLISM,
 VAGINAL  OR  BLADDER  PROBLEMS,  DECREASE  IN  FERTILITY,  LOSS OF BONE,
 INCREASE  IN  LOW-DENSITY  LIPOPROTEIN  CHOLESTEROL  LEVELS,  AND  SLEEP
 DISRUPTION INCLUDING NIGHT SWEATS.
   (2) FOR PURPOSES OF PARAGRAPH ONE OF THIS SUBSECTION:
   (A)  "MENOPAUSE"  MEANS THE PERMANENT CESSATION OF MENSTRUATION DUE TO
 LOSS OF OVARIAN FOLLICULAR FUNCTION, WHERE OVARIES STOP  RELEASING  EGGS
 AND THE BODY PRODUCES LESS ESTROGEN AND PROGESTERONE.
   (B)  "PERIMENOPAUSE"  MEANS  THE TRANSITION PERIOD IN WHICH A WOMAN IS
 NEAR THE END OF HER REPRODUCTIVE YEARS OR AT THE ONSET OF MENOPAUSE.
   (3)  SUCH  COVERAGE  REQUIRED  PURSUANT  TO  PARAGRAPH  ONE  OF   THIS
 SUBSECTION  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 CONTRACT.
   §  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
 policies issued, reissued, renewed, modified or amended on or after such
 date.