Senate Bill S5556

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5556
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             February 25, 2025
                                ___________
 
 Introduced by Sens. HOYLMAN-SIGAL, WEBB -- read twice and ordered print-
   ed, and when printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law, in relation to prohibiting the exclu-
   sion of coverage based upon gender indication on claim forms
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
 amended by adding a new paragraph 41 to read as follows:
   (41)  EVERY  POLICY  THAT  PROVIDES COVERAGE FOR HOSPITAL, SURGICAL OR
 MEDICAL CARE SHALL NOT EXCLUDE COVERAGE  FOR  SCREENING,  DIAGNOSIS  AND
 TREATMENT  OF  MEDICAL  CONDITIONS, OR SERVICES OTHERWISE COVERED BY THE
 POLICY SOLELY ON THE BASIS OF THE GENDER INDICATED ON A CLAIM  FORM,  OR
 THAT  THE  GENDER  INDICATED  ON  A  CLAIM  FORM  IS  DIFFERENT FROM THE
 INSURED'S SEX ASSIGNED AT BIRTH OR GENDER OTHERWISE  RECORDED,  OR  THAT
 THE  INSURED IS NOT OF THE GENDER TO WHOM A SERVICE IS PROVIDED. NOTHING
 HEREIN SHALL LIMIT THE  INSURER'S  ABILITY  TO  TAKE  REASONABLE  STEPS,
 INCLUDING  REQUESTING  ADDITIONAL  INFORMATION, TO DETERMINE WHETHER THE
 INSURED IS ELIGIBLE FOR THE SERVICES, TO REVIEW THE CLAIM FOR  POTENTIAL
 FRAUD, OR TO REVIEW THE CLAIM FOR CLINICAL APPROPRIATENESS.
   § 2. Subsection (l) of section 3221 of the insurance law is amended by
 adding a new paragraph 24 to read as follows:
   (24)  EVERY  POLICY  THAT  PROVIDES COVERAGE FOR HOSPITAL, SURGICAL OR
 MEDICAL CARE SHALL NOT EXCLUDE COVERAGE  FOR  SCREENING,  DIAGNOSIS  AND
 TREATMENT  OF  MEDICAL  CONDITIONS, OR SERVICES OTHERWISE COVERED BY THE
 POLICY SOLELY ON THE BASIS OF THE GENDER INDICATED ON A CLAIM  FORM,  OR
 THAT  THE  GENDER  INDICATED  ON  A  CLAIM  FORM  IS  DIFFERENT FROM THE
 INSURED'S SEX ASSIGNED AT BIRTH OR GENDER OTHERWISE  RECORDED,  OR  THAT
 THE  INSURED IS NOT OF THE GENDER TO WHOM A SERVICE IS PROVIDED. NOTHING
 HEREIN SHALL LIMIT THE  INSURER'S  ABILITY  TO  TAKE  REASONABLE  STEPS,
 INCLUDING  REQUESTING  ADDITIONAL  INFORMATION, TO DETERMINE WHETHER THE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07854-02-5
 S. 5556                             2
              

 
 INSURED IS ELIGIBLE FOR THE SERVICES, TO REVIEW THE CLAIM FOR  POTENTIAL
 FRAUD, OR TO REVIEW THE CLAIM FOR CLINICAL APPROPRIATENESS.
   §  3.  Section  4303  of  the insurance law is amended by adding a new
 subsection (ww) to read as follows:
   (WW) EVERY CONTRACT THAT PROVIDES COVERAGE FOR HOSPITAL,  SURGICAL  OR
 MEDICAL  CARE  SHALL  NOT  EXCLUDE COVERAGE FOR SCREENING, DIAGNOSIS AND
 TREATMENT OF MEDICAL CONDITIONS, OR SERVICES OTHERWISE  COVERED  BY  THE
 CONTRACT SOLELY ON THE BASIS OF THE GENDER INDICATED ON A CLAIM FORM, OR
 THAT  THE  GENDER  INDICATED  ON  A  CLAIM  FORM  IS  DIFFERENT FROM THE
 INSURED'S SEX ASSIGNED AT BIRTH OR GENDER OTHERWISE  RECORDED,  OR  THAT
 THE  INSURED IS NOT OF THE GENDER TO WHOM A SERVICE IS PROVIDED. NOTHING
 HEREIN SHALL LIMIT THE  INSURER'S  ABILITY  TO  TAKE  REASONABLE  STEPS,
 INCLUDING  REQUESTING  ADDITIONAL  INFORMATION, TO DETERMINE WHETHER THE
 INSURED IS ELIGIBLE FOR THE SERVICES, TO REVIEW THE CLAIM FOR  POTENTIAL
 FRAUD, OR TO REVIEW THE CLAIM FOR CLINICAL APPROPRIATENESS.
   §  4. This act shall take effect on the first of January next succeed-
 ing the date on which it shall have become a  law  and  shall  apply  to
 policies  and contracts issued, renewed, modified, altered or amended on
 or after such effective date.