S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7304
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 25, 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  prohibiting  private
   insurers  from  charging  co-payments for an annual pediatric eye exam
   completed by an optometrist or ophthalmologist

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraphs (B) and (C) of paragraph 17 of subsection (i)
 of  section  3216 of the insurance law, as amended by chapter 219 of the
 laws of 2011, are amended to read as follows:
   (B) For the purposes of subparagraphs (A), (C) and (D) of  this  para-
 graph, preventive and primary care services means the following services
 rendered to a covered child of an insured from the date of birth through
 the attainment of nineteen years;
   (i)  an  initial  hospital check-up and well-child visits scheduled in
 accordance with the prevailing clinical standards of a national  associ-
 ation  of  pediatric physicians designated by the commissioner of health
 (except for any standard that would limit  the  specialty  or  forum  of
 licensure  of  the  practitioner  providing  the  service other than the
 limits under state law). Coverage for such services  rendered  shall  be
 provided  only to the extent that such services are provided by or under
 the supervision of a physician, or  other  professional  licensed  under
 article  one  hundred  thirty-nine  of  the education law whose scope of
 practice pursuant to such law includes  the  authority  to  provide  the
 specified  services.  Coverage  shall  be  provided  for  such  services
 rendered in a hospital, as defined in section twenty-eight  hundred  one
 of  the  public  health  law,  or  in  an office of a physician or other
 professional licensed under  article  one  hundred  thirty-nine  of  the
 education  law whose scope of practice pursuant to such law includes the
 authority to provide the specified services;
   (ii) at each visit, services in accordance with the  prevailing  clin-
 ical  standards  of  such  designated  association,  including a medical
 history, a  complete  physical  examination,  developmental  assessment,
 anticipatory  guidance,  appropriate  immunizations and laboratory tests
 
              

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11258-01-5
 A. 7304                             2
 
 which tests are ordered at the time of the visit and  performed  in  the
 practitioner's  office, as authorized by law, or in a clinical laborato-
 ry; [and]
   (iii)  necessary immunizations, as determined by the superintendent in
 consultation with the commissioner of health,  consisting  of  at  least
 adequate  dosages  of  vaccine  against  diphtheria, pertussis, tetanus,
 polio, measles, rubella, mumps, haemophilus influenzae type b and  hepa-
 titis  b,  which meet the standards approved by the United States public
 health service for such biological products[.]; AND
   (IV) A PEDIATRIC EYE EXAMINATION BY AN OPTOMETRIST OR  OPHTHALMOLOGIST
 ONCE EVERY CALENDAR YEAR, REGARDLESS OF WHETHER OR NOT A PERIOD OF THREE
 HUNDRED SIXTY-FIVE DAYS HAS PASSED SINCE THE PREVIOUS EXAMINATION.
   (C) Such coverage required pursuant to subparagraph (A) or (B) of this
 paragraph  shall  not  be  subject to annual deductibles or coinsurance.
 COVERAGE REQUIRED PURSUANT TO CLAUSE (IV) OF SUBPARAGRAPH  (B)  OF  THIS
 PARAGRAPH SHALL NOT BE SUBJECT TO A CO-PAYMENT.
   §  2.  Subparagraphs  (B)  and (C) of paragraph 8 of subsection (l) of
 section 3221 of the insurance  law, as amended by  chapter  219  of  the
 laws of 2011, is amended  to  read  as follows:
   (B)  In  subparagraphs  (A), (C) and (D) of this paragraph, preventive
 and primary care services means the following  services  rendered  to  a
 covered  child  of an insured from the date of birth through the attain-
 ment of nineteen years of age:
   (i) an initial hospital check-up and well-child  visits  scheduled  in
 accordance  with the prevailing clinical standards of a national associ-
 ation of pediatric physicians designated by the commissioner  of  health
 (except  for  any  standard  that  would limit the specialty or forum of
 licensure of the practitioner  providing  the  service  other  than  the
 limits  under  state  law). Coverage for such services rendered shall be
 provided only to the extent that such services are provided by or  under
 the  supervision  of  a  physician, or other professional licensed under
 article one hundred thirty-nine of the  education  law  whose  scope  of
 practice  pursuant  to  such  law  includes the authority to provide the
 specified  services.  Coverage  shall  be  provided  for  such  services
 rendered  in  a hospital, as defined in section twenty-eight hundred one
 of the public health law, or in  an  office  of  a  physician  or  other
 professional  licensed  under  article  one  hundred  thirty-nine of the
 education law whose scope of practice pursuant to such law includes  the
 authority to provide the specified services;
   (ii)  at  each visit, services in accordance with the prevailing clin-
 ical standards of  such  designated  association,  including  a  medical
 history,  a  complete  physical  examination,  developmental assessment,
 anticipatory guidance, appropriate immunizations  and  laboratory  tests
 which  tests  are  ordered at the time of the visit and performed in the
 practitioner's office, as authorized by law, or in a clinical  laborato-
 ry; [and]
   (iii)  necessary immunizations, as determined by the superintendent in
 consultation with the commissioner of health,  consisting  of  at  least
 adequate  dosages  of  vaccine  against  diphtheria, pertussis, tetanus,
 polio, measles, rubella, mumps, haemophilus influenzae type b and  hepa-
 titis  b,  which meet the standards approved by the United States public
 health service for such biological products[.]; AND
   (IV) A PEDIATRIC EYE EXAMINATION BY AN OPTOMETRIST OR  OPHTHALMOLOGIST
 ONCE EVERY CALENDAR YEAR, REGARDLESS OF WHETHER OR NOT A PERIOD OF THREE
 HUNDRED SIXTY-FIVE DAYS HAS PASSED SINCE THE PREVIOUS EXAMINATION.
 A. 7304                             3
 
   (C) Such coverage required pursuant to subparagraph (A) or (B) of this
 paragraph  shall  not  be  subject to annual deductibles or coinsurance.
 COVERAGE REQUIRED PURSUANT TO CLAUSE (IV) OF SUBPARAGRAPH  (B)  OF  THIS
 PARAGRAPH SHALL NOT BE SUBJECT TO A CO-PAYMENT.
   §  3.  Paragraph  2 of subsection (j) of section 4303 of the insurance
 law, as amended by chapter 219 of the laws of 2011, is amended  to  read
 as follows:
   (2)  For  purposes  of  this  paragraph  and  paragraph  one  of  this
 subsection, preventive and primary care services shall mean the  follow-
 ing  services  rendered to a covered child of a subscriber from the date
 of birth through the attainment of nineteen years of age:
   (A) an initial hospital check-up and well-child  visits  scheduled  in
 accordance  with the prevailing clinical standards of a national associ-
 ation of pediatric physicians designated by the commissioner  of  health
 (except  for  any  standard  that  would limit the specialty or forum of
 licensure of the practitioner  providing  the  service  other  than  the
 limits  under  state  law). Coverage for such services rendered shall be
 provided only to the extent that such services are provided by or  under
 the  supervision  of  a  physician, or other professional licensed under
 article one hundred thirty-nine of the  education  law  whose  scope  of
 practice  pursuant  to  such  law  includes the authority to provide the
 specified  services.  Coverage  shall  be  provided  for  such  services
 rendered  in  a hospital, as defined in section twenty-eight hundred one
 of the public health law, or in  an  office  of  a  physician  or  other
 professional  licensed  under  article  one  hundred  thirty-nine of the
 education law whose scope of practice pursuant to such law includes  the
 authority to provide the specified services,
   (B) at each visit, services in accordance with the prevailing clinical
 standards of such designated association, including a medical history, a
 complete  physical  examination,  developmental assessment, anticipatory
 guidance, appropriate immunizations and laboratory tests which tests are
 ordered at the time of the visit and  performed  in  the  practitioner's
 office, as authorized by law, or in a clinical laboratory, [and]
   (C)  necessary  immunizations,  as determined by the superintendent in
 consultation with the commissioner of health,  consisting  of  at  least
 adequate  dosages  of  vaccine  against  diphtheria, pertussis, tetanus,
 polio, measles, rubella, mumps, haemophilus influenzae type b and  hepa-
 titis  b,  which meet the standards approved by the United States public
 health service for such biological products[.], AND
   (D) A PEDIATRIC EYE EXAMINATION BY AN OPTOMETRIST  OR  OPHTHALMOLOGIST
 ONCE EVERY CALENDAR YEAR, REGARDLESS OF WHETHER OR NOT A PERIOD OF THREE
 HUNDRED SIXTY-FIVE DAYS HAS PASSED SINCE THE PREVIOUS EXAMINATION.
   (E)  Such  coverage  required pursuant to this paragraph and paragraph
 one of this subsection shall not be subject  to  annual  deductibles  or
 coinsurance.  COVERAGE  REQUIRED  PURSUANT  TO  SUBPARAGRAPH (D) OF THIS
 PARAGRAPH SHALL NOT BE SUBJECT TO A CO-PAYMENT.
   [(E)] (F) Such coverage required pursuant to this paragraph and  para-
 graph  one  of  this subsection shall not restrict or eliminate existing
 coverage provided by the contract.
   § 4. This act shall take effect on the one hundred eightieth day after
 it shall have become a law.  Effective immediately, the addition, amend-
 ment and/or repeal of any rule or regulation necessary for the implemen-
 tation of this act on its effective date are authorized to be  made  and
 completed on or before such effective date.