S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6596--A
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               March 6, 2025
                                ___________
 
 Introduced  by  M.  of  A.  ROSENTHAL,  CRUZ, GONZALEZ-ROJAS, SEAWRIGHT,
   O'PHARROW,  LUNSFORD,  DAVILA,   SIMONE,   EPSTEIN,   REYES,   ROMERO,
   P. CARROLL, MEEKS -- read once and referred to the Committee on Health
   --  committee  discharged,  bill amended, ordered reprinted as amended
   and recommitted to said committee

 AN ACT to amend the social services law, in relation to requiring  Medi-
   caid  to cover gender-affirming care regardless of federal funding; to
   amend the executive law, in  relation  to  prohibiting  discriminatory
   practices  by health care entities; and to amend the insurance law, in
   relation to prohibiting discriminatory practices by  insurers  and  to
   coverage for treatment for gender dysphoria or gender incongruence
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 2 of section 365-a of the social  services  law
 is amended by adding a new paragraph (oo) to read as follows:
   (OO)  ALL  MEDICALLY  NECESSARY  GENDER-AFFIRMING  CARE  REGARDLESS OF
 WHETHER ANY FEDERAL FUNDS ARE AVAILABLE FOR SUCH COVERAGE.
   § 2. The executive law is amended by adding a  new  section  296-e  to
 read as follows:
   § 296-E. UNLAWFUL DISCRIMINATORY PRACTICES IN RELATION TO HEALTH CARE.
 1.  FOR  THE  PURPOSES  OF  THIS  SECTION, THE TERM "HEALTH CARE ENTITY"
 MEANS:
   (A) A HOSPITAL OR PROVIDER AS DEFINED BY SECTION TWENTY-EIGHT  HUNDRED
 ONE  OF  THE  PUBLIC  HEALTH LAW; INCLUDING THOSE DEFINED IN SECTION TWO
 HUNDRED NINETY-TWO OF THIS ARTICLE; OR
   (B) A PROFESSIONAL LICENSED UNDER ARTICLE ONE HUNDRED THIRTY-ONE,  ONE
 HUNDRED  THIRTY-ONE-B, ONE HUNDRED THIRTY-ONE-C, ONE HUNDRED THIRTY-TWO,
 ONE HUNDRED THIRTY-THREE, ONE HUNDRED THIRTY-FOUR, ONE  HUNDRED  THIRTY-
 SIX,  ONE  HUNDRED THIRTY-SEVEN, ONE HUNDRED THIRTY-SEVEN-A, ONE HUNDRED
 THIRTY-NINE, ONE HUNDRED  FORTY,  ONE  HUNDRED  FORTY-ONE,  ONE  HUNDRED
 FORTY-THREE,  ONE  HUNDRED  FORTY-FOUR,  ONE  HUNDRED  FIFTY-THREE,  ONE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09201-07-5
              

 A. 6596--A                          2
 
 HUNDRED FIFTY-SEVEN, ONE HUNDRED SIXTY-THREE, ONE HUNDRED SIXTY-FOUR, OR
 ONE HUNDRED SIXTY-SEVEN OF THE EDUCATION LAW; OR
   (C) AN ISSUER OR PROVIDER OF COVERAGE FOR HEALTH INSURANCE, AS DEFINED
 BY SECTION SEVEN THOUSAND SEVEN HUNDRED FIVE OF THE INSURANCE LAW.
   2. IT SHALL BE AN UNLAWFUL DISCRIMINATORY PRACTICE FOR ANY HEALTH CARE
 ENTITY  TO  REFUSE  SERVICES  OR  TO  OTHERWISE DISCRIMINATE AGAINST ANY
 PERSON ON THE BASIS OF SUCH PERSON'S AGE, RACE, CREED,  COLOR,  NATIONAL
 ORIGIN,  CITIZENSHIP  OR  IMMIGRATION STATUS, SEXUAL ORIENTATION, GENDER
 IDENTITY OR EXPRESSION, MILITARY STATUS, SEX,  DISABILITY,  PREDISPOSING
 GENETIC CHARACTERISTICS, FAMILIAL STATUS, MARITAL STATUS, OR STATUS AS A
 VICTIM OF DOMESTIC VIOLENCE.
   § 3. The section heading and the opening paragraph and paragraphs 4, 7
 and  8  of subsection (a) of section 3243 of the insurance law, as added
 by section 2 of subpart D of part J of chapter 57 of the laws  of  2019,
 are  amended  and four new paragraphs 9, 10, 11 and 12 are added to read
 as follows:
   Discrimination because of RACE, NATIONAL ORIGIN, AGE, DISABILITY,  sex
 or marital status in hospital, surgical or medical expense insurance.
   With  regard  to an accident and health insurance policy that provides
 hospital, surgical, or medical expense coverage or a policy  of  student
 accident  and  health insurance, as defined in subsection (a) of section
 three thousand two hundred forty of this article,  delivered  or  issued
 for  delivery  in  this  state, no insurer shall because of RACE, COLOR,
 CREED, NATIONAL ORIGIN, sex,  marital  status,  DISABILITY,  PREEXISTING
 CONDITION,  or based on pregnancy, false pregnancy, termination of preg-
 nancy, or recovery therefrom, childbirth or related medical conditions:
   (4) insert in the policy  any  condition,  or  make  any  stipulation,
 whereby  the  insured binds [his or herself] THEMSELVES, or [his or her]
 SUCH INSURED'S heirs, executors, administrators or  assigns,  to  accept
 any  sum or service less than the full value or amount of such policy in
 case of a claim thereon except such conditions and stipulations  as  are
 imposed upon others in similar cases; and any such stipulation or condi-
 tion so made or inserted shall be void;
   (7)  fix  any lower rate or discriminate in the fees or commissions of
 insurance agents or insurance brokers for writing  or  renewing  such  a
 policy; [or]
   (8) engage in sexual stereotyping[.];
   (9)  INCLUDE  A POLICY CLAUSE THAT PURPORTS TO DENY, LIMIT, OR EXCLUDE
 COVERAGE BASED ON AN INSURED'S SEXUAL ORIENTATION,  GENDER  IDENTITY  OR
 EXPRESSION, OR TRANSGENDER STATUS;
   (10) DENY, LIMIT, OR OTHERWISE EXCLUDE MEDICALLY NECESSARY SERVICES OR
 TREATMENT  OTHERWISE COVERED BY A POLICY ON THE BASIS THAT THE TREATMENT
 IS FOR GENDER DYSPHORIA OR GENDER INCONGRUENCE; PROVIDED FURTHER THAT AN
 INSURER SHALL PROVIDE AN INSURED  WITH  THE  UTILIZATION  REVIEW  APPEAL
 RIGHTS  REQUIRED  BY INSURANCE LAW AND PUBLIC HEALTH LAW ARTICLES 49 FOR
 GENDER DYSPHORIA OR GENDER INCONGRUENCE TREATMENT THAT IS  DENIED  BASED
 ON MEDICAL NECESSITY;
   (11)  DESIGNATE  AN  INSURED'S  SEXUAL ORIENTATION, GENDER IDENTITY OR
 EXPRESSION, OR TRANSGENDER STATUS AS A PRE-EXISTING  CONDITION  FOR  THE
 PURPOSE OF DENYING, LIMITING, OR EXCLUDING COVERAGE; OR
   (12)  DENY  A CLAIM FROM AN INSURED OF ONE GENDER OR SEX FOR A SERVICE
 THAT IS TYPICALLY OR EXCLUSIVELY PROVIDED TO AN  INDIVIDUAL  OF  ANOTHER
 GENDER  OR  SEX UNLESS THE INSURER HAS TAKEN REASONABLE STEPS, INCLUDING
 REQUESTING ADDITIONAL INFORMATION, TO DETERMINE WHETHER THE  INSURED  IS
 ELIGIBLE FOR THE SERVICES PRIOR TO DENIAL OF SUCH CLAIM.
 A. 6596--A                          3
 
   §  4.  Section  4303  of  the insurance law is amended by adding a new
 subsection (ww) to read as follows:
   (WW)(1)  EVERY  POLICY  WHICH  PROVIDES HOSPITAL, SURGICAL, OR MEDICAL
 COVERAGE SHALL PROVIDE MEDICALLY NECESSARY SERVICES OR TREATMENT  OTHER-
 WISE  COVERED  BY A POLICY ON THE BASIS THAT THE TREATMENT IS FOR GENDER
 DYSPHORIA OR GENDER INCONGRUENCE.
   (2) COVERAGE FOR GENDER DYSPHORIA OR GENDER INCONGRUENCE SHALL NOT  BE
 SUBJECT  TO  ANNUAL  DEDUCTIBLES  OR COINSURANCE, INCLUDING CO-PAYMENTS,
 UNLESS THE POLICY IS A HIGH DEDUCTIBLE HEALTH PLAN AS DEFINED IN SECTION
 223(C)(2) OF THE INTERNAL REVENUE CODE OF 1986, IN WHICH  CASE  COVERAGE
 FOR GENDER DYSPHORIA OR GENDER INCONGRUENCE MAY BE SUBJECT TO THE PLAN'S
 ANNUAL DEDUCTIBLE.
   § 5. 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 WHICH PROVIDES HOSPITAL, SURGICAL, OR MEDICAL
 COVERAGE SHALL ALSO PROVIDE COVERAGE FOR MEDICALLY NECESSARY SERVICES OR
 TREATMENTS FOR GENDER DYSPHORIA OR GENDER INCONGRUENCE THAT  ARE  OTHER-
 WISE COVERED BY THE POLICY.
   (B) COVERAGE FOR THE TREATMENT OF GENDER DYSPHORIA OR GENDER INCONGRU-
 ENCE  SHALL NOT BE SUBJECT TO ANNUAL DEDUCTIBLES OR COINSURANCE, INCLUD-
 ING CO-PAYMENTS, UNLESS THE POLICY IS A HIGH DEDUCTIBLE HEALTH  PLAN  AS
 DEFINED  IN  SECTION  223(C)(2) OF THE INTERNAL REVENUE CODE OF 1986, IN
 WHICH CASE COVERAGE FOR GENDER DYSPHORIA OR GENDER INCONGRUENCE  MAY  BE
 SUBJECT TO THE PLAN'S ANNUAL DEDUCTIBLE.
   § 6. Subsection (i) of section 3216 of the insurance law is amended by
 adding a new paragraph 41 to read as follows:
   (41)(A)  EVERY  POLICY  WHICH  PROVIDES HOSPITAL, SURGICAL, OR MEDICAL
 COVERAGE SHALL ALSO PROVIDE COVERAGE FOR MEDICALLY NECESSARY SERVICES OR
 TREATMENTS FOR GENDER DYSPHORIA OR GENDER INCONGRUENCE THAT  ARE  OTHER-
 WISE COVERED BY THE POLICY.
   (B)  COVERAGE FOR GENDER DYSPHORIA OR GENDER INCONGRUENCE SHALL NOT BE
 SUBJECT TO ANNUAL DEDUCTIBLES  OR  COINSURANCE,  INCLUDING  CO-PAYMENTS,
 UNLESS THE POLICY IS A HIGH DEDUCTIBLE HEALTH PLAN AS DEFINED IN SECTION
 223(C)(2)  OF  THE INTERNAL REVENUE CODE OF 1986, IN WHICH CASE COVERAGE
 FOR GENDER DYSPHORIA OR GENDER INCONGRUENCE MAY BE SUBJECT TO THE PLAN'S
 ANNUAL DEDUCTIBLE.
   § 7. This act shall take effect immediately.