S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7553
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               April 1, 2025
                                ___________
 
 Introduced  by  M.  of  A. SANTABARBARA -- read once and referred to the
   Committee on Insurance
 
 AN ACT to amend the insurance  law,  in  relation  to  requiring  health
   insurance  contracts  provide  coverage  to  developmentally  disabled
   persons beyond twenty-six years of age

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Subparagraph  (C)  of  paragraph  4  of subsection (a) of
 section 3216 of the insurance law, as amended by chapter 219 of the laws
 of 2011, is amended to read as follows:
   (C) In addition to the requirements of subparagraphs (A)  and  (B)  of
 this  paragraph, every insurer issuing a policy of hospital, medical, or
 surgical expense insurance pursuant to this section that provides cover-
 age for dependent children must make available and, if requested by  the
 policyholder,  extend  coverage  under  the policy to an unmarried child
 through age twenty-nine, without regard to financial dependence  who  is
 not insured by or eligible for coverage under an employer health benefit
 plan  as an employee or member, whether insured or self-insured, and who
 lives, works or resides in New York state or the  service  area  of  the
 insurer.  Such  coverage shall be made available at the inception of all
 new policies. Written notice of the availability of such coverage  shall
 be  delivered  to the policyholder [thirty days] SIX MONTHS prior to the
 inception of such policy. WHERE AN UNMARRIED DEPENDENT CHILD IS  INCAPA-
 BLE OF SELF-SUSTAINING EMPLOYMENT BY REASON OF MENTAL ILLNESS, OR DEVEL-
 OPMENTAL  DISABILITY  AS  DEFINED IN THE MENTAL HYGIENE LAW, OR PHYSICAL
 HANDICAP AND WHO BECAME SO INCAPABLE PRIOR TO THE AGE AT WHICH DEPENDENT
 COVERAGE WOULD OTHERWISE  TERMINATE  SUCH  COVERAGE  SHALL  BE  EXTENDED
 INDEFINITELY PAST AGE TWENTY-SIX.
   § 2. Subparagraph (B) of paragraph 5 of subsection (c) of section 3216
 of  the insurance law, as amended by chapter 479 of the laws of 2022, is
 amended to read as follows:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10447-01-5
              

 A. 7553                             2
 
   (B) Written notice of entitlement to  a  conversion  policy  shall  be
 given  by the insurer to the policyholder at least [fifteen and not more
 than sixty days] SIX MONTHS prior to the termination of coverage due  to
 the  initial  limiting  age  of the covered dependent. Such notice shall
 include  an  explanation  of the rights of the dependent with respect to
 the dependent being enrolled in an accredited institution of learning or
 [his or her] SUCH DEPENDENT'S incapacity for self-sustaining  employment
 by  reason of mental illness, developmental disability as defined in the
 mental hygiene law or physical [handicap] DISABILITY.
   § 3. The insurance law is amended by adding a new section 3246 to read
 as follows:
   § 3246. CERTAIN  INDIVIDUAL  ACCIDENT  AND  HEALTH  INSURANCE   POLICY
 PROVISIONS  FOR  DEVELOPMENTALLY  DISABLED  PERSONS.  1. ANY CORPORATION
 SUBJECT TO THE PROVISIONS OF THIS ARTICLE OFFERING ANY INDIVIDUAL POLICY
 OR CONTRACT COVERING THE KIND OR KINDS OF  INSURANCE  FOR  AN  UNMARRIED
 DEPENDENT CHILD WHO IS INCAPABLE OF SELF-SUSTAINING EMPLOYMENT BY REASON
 OF  MENTAL ILLNESS, OR DEVELOPMENTAL DISABILITY AS DEFINED IN THE MENTAL
 HYGIENE LAW, OR PHYSICAL DISABILITY AND WHO BECAME SO INCAPABLE PRIOR TO
 THE AGE AT WHICH DEPENDENT COVERAGE WOULD OTHERWISE TERMINATE  SHALL  BE
 PROHIBITED  FROM TERMINATING COVERAGE BASED ON AGE, EMPLOYMENT, OR MARI-
 TAL STATUS IF SUCH DEPENDENT CHILD IS UNMARRIED.
   2. IF THE SUPERINTENDENT FINDS, AFTER  NOTICE  AND  HEARING,  THAT  AN
 INSURER  HAS  KNOWINGLY  AND  WRONGFULLY VIOLATED THE PROVISIONS OF THIS
 SECTION, THE SUPERINTENDENT MAY IMPOSE A CIVIL PENALTY OF NOT MORE  THAN
 TEN THOUSAND DOLLARS FOR EACH VIOLATION.
   § 4. The insurance law is amended by adding a new section 3247 to read
 as follows:
   § 3247. RECERTIFICATION  OF A DEVELOPMENTALLY DISABLED PERSON'S CONDI-
 TION. NO CORPORATION SUBJECT TO THE PROVISIONS OF THIS ARTICLE  OFFERING
 AN INDIVIDUAL POLICY OR CONTRACT COVERING THE KIND OR KINDS OF INSURANCE
 FOR  AN  UNMARRIED  DEPENDENT  CHILD WHO IS INCAPABLE OF SELF-SUSTAINING
 EMPLOYMENT BY REASON OF MENTAL ILLNESS, OR DEVELOPMENTAL  DISABILITY  AS
 DEFINED IN THE MENTAL HYGIENE LAW, OR PHYSICAL DISABILITY AND WHO BECAME
 SO  INCAPABLE  PRIOR TO THE AGE AT WHICH DEPENDENT COVERAGE WOULD OTHER-
 WISE TERMINATE SHALL REQUEST RECERTIFICATION OF AN  UNMARRIED  DEPENDENT
 CHILD'S  CONDITION MORE THAN ONCE EVERY FIVE YEARS, UNLESS A SUBSTANTIAL
 CHANGE IN AN UNMARRIED DEPENDENT CHILD'S CONDITION OCCURS.
   § 5. Paragraph 3 of subsection (d) of section 4304  of  the  insurance
 law,  as  amended by chapter 479 of the laws of 2022, is amended to read
 as follows:
   (3) Coverage of an unmarried dependent child who is incapable of self-
 sustaining employment by reason of mental illness,  developmental  disa-
 bility,  as  defined  in  the mental hygiene law, or physical [handicap]
 DISABILITY and who became so incapable prior to attainment of the age at
 which coverage would otherwise terminate and who  is  chiefly  dependent
 upon  the  contract holder for support and maintenance, shall not termi-
 nate while the contract remains in force and the child remains  in  such
 condition,  if  the  contract  holder has within thirty-one days of such
 child's attainment of the limiting age submitted proof of  such  child's
 incapacity  as described herein. A CONTRACT HOLDER SHALL BE PROVIDED SIX
 MONTHS' NOTICE ADVISING SUCH CONTRACT HOLDER THAT COVERAGE WOULD  OTHER-
 WISE TERMINATE IF NO SUCH PROOF OF A CHILD'S INCAPACITY IS SUBMITTED.
   § 6. Item (ii) of subparagraph (A) of paragraph 1 of subsection (c) of
 section 4305 of the insurance law, as amended by chapter 479 of the laws
 of 2022, is amended to read as follows:
 A. 7553                             3
 
   (ii)  a  contract  under  which coverage terminates at a specified age
 shall, with respect to an unmarried child who is incapable of  self-sus-
 taining  employment by reason of mental illness, developmental disabili-
 ty, as defined in the mental hygiene law, or physical  [handicap]  DISA-
 BILITY  and  who  became  so incapable prior to attainment of the age at
 which coverage would otherwise terminate and who  is  chiefly  dependent
 upon such member for support and maintenance, not so terminate while the
 contract  remains  in  force and the child remains in such condition, if
 the member has within thirty-one days of such child's attainment of  the
 termination  age submitted proof of such child's incapacity as described
 herein. A CONTRACT HOLDER SHALL BE PROVIDED SIX MONTHS' NOTICE  ADVISING
 SUCH  CONTRACT HOLDER THAT COVERAGE WOULD OTHERWISE TERMINATE IF NO SUCH
 PROOF OF A CHILD'S INCAPACITY IS SUBMITTED.
   § 7. The insurance law is amended by adding a new section 4331 to read
 as follows:
   § 4331. CERTAIN INDIVIDUAL AND GROUP CONTRACTS HEALTH INSURANCE POLICY
 PROVISIONS FOR DEVELOPMENTALLY  DISABLED  PERSONS.  1.  ANY  CORPORATION
 SUBJECT  TO  THE  PROVISIONS  OF  THIS  ARTICLE  OFFERING  ANY POLICY OR
 CONTRACT COVERING THE KIND  OR  KINDS  OF  INSURANCE  FOR  AN  UNMARRIED
 DEPENDENT CHILD WHO IS INCAPABLE OF SELF-SUSTAINING EMPLOYMENT BY REASON
 OF  MENTAL ILLNESS, OR DEVELOPMENTAL DISABILITY AS DEFINED IN THE MENTAL
 HYGIENE LAW, OR PHYSICAL DISABILITY AND WHO BECAME SO INCAPABLE PRIOR TO
 THE AGE AT WHICH DEPENDENT COVERAGE WOULD OTHERWISE TERMINATE  SHALL  BE
 PROHIBITED  FROM TERMINATING COVERAGE BASED ON AGE, EMPLOYMENT, OR MARI-
 TAL STATUS IF SUCH DEPENDENT CHILD IS UNMARRIED.
   2. IF THE SUPERINTENDENT FINDS, AFTER  NOTICE  AND  HEARING,  THAT  AN
 INSURER  HAS  KNOWINGLY  AND  WRONGFULLY VIOLATED THE PROVISIONS OF THIS
 SECTION, THE SUPERINTENDENT MAY IMPOSE A CIVIL PENALTY OF NOT MORE  THAN
 TEN THOUSAND DOLLARS FOR EACH VIOLATION.
   § 8. The insurance law is amended by adding a new section 4332 to read
 as follows:
   § 4332. RECERTIFICATION  OF A DEVELOPMENTALLY DISABLED PERSON'S CONDI-
 TION. NO CORPORATION SUBJECT TO THE PROVISIONS OF THIS ARTICLE  OFFERING
 AN INDIVIDUAL POLICY OR CONTRACT COVERING THE KIND OR KINDS OF INSURANCE
 FOR  AN  UNMARRIED  DEPENDENT  CHILD WHO IS INCAPABLE OF SELF-SUSTAINING
 EMPLOYMENT BY REASON OF MENTAL ILLNESS, OR DEVELOPMENTAL  DISABILITY  AS
 DEFINED IN THE MENTAL HYGIENE LAW, OR PHYSICAL DISABILITY AND WHO BECAME
 SO  INCAPABLE  PRIOR TO THE AGE AT WHICH DEPENDENT COVERAGE WOULD OTHER-
 WISE TERMINATE SHALL REQUEST RECERTIFICATION OF AN  UNMARRIED  DEPENDENT
 CHILD'S  CONDITION MORE THAN ONCE EVERY FIVE YEARS, UNLESS A SUBSTANTIAL
 CHANGE IN AN UNMARRIED DEPENDENT CHILD'S CONDITION OCCURS.
   § 9. This act shall take effect January 1, 2026  and  shall  apply  to
 policies  and contracts issued, renewed, modified, altered or amended on
 or after such date.