Senate Bill S5313

                             
                     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.