S T A T E O F N E W Y O R K
________________________________________________________________________
5313--A
Cal. No. 425
2025-2026 Regular Sessions
I N S E N A T E
February 20, 2025
___________
Introduced by Sens. BAILEY, GALLIVAN, GOUNARDES, HARCKHAM -- read twice
and ordered printed, and when printed to be committed to the Committee
on Insurance -- reported favorably from said committee, ordered to
first and second report, ordered to a third reading, amended and
ordered reprinted, retaining its place in the order of third reading
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. Subsection (c) of section 3216 of the insurance law is
amended by adding a new paragraph 16 to read as follows:
(16) (A) ALL POLICIES PROVIDING COVERAGE OF DENTAL SERVICES ISSUED
PURSUANT TO THIS SECTION SHALL INCLUDE THE FOLLOWING DISCLOSURE: "IMPOR-
TANT: 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."
(B) FOR PURPOSES OF THIS PARAGRAPH, "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 (a) of section 3221 of the insurance law is amended by
adding a new paragraph 18 to read as follows:
(18) (A) ALL POLICIES PROVIDING COVERAGE OF 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."
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD07721-05-5
S. 5313--A 2
(B) FOR THE PURPOSES OF THIS PARAGRAPH, "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. 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.
(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.
§ 4. This act shall take effect January 1, 2027 and shall apply to all
insurance contracts issued or entered into on or after such date.