S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    760
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 8, 2025
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed to the Committee on Rules
 
 AN ACT to amend the insurance  law,  in  relation  to  requiring  health
   insurance  plans  to  provide  coverage  for epinephrine auto-injector
   devices

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Subparagraph  (A)  of  paragraph  39 of subsection (i) of
 section 3216 of the insurance law, as added by a chapter of the laws  of
 2024  amending  the insurance law relating to requiring health insurance
 plans to provide coverage  for  epinephrine  auto-injector  devices,  as
 proposed  in  legislative  bills  numbers  S.  7114-A  and A. 6425-A, is
 amended to read as follows:
   (A) Every insurer issuing a policy of accident  and  health  insurance
 delivered  or  issued  for  delivery  in this state which provides major
 medical or similar comprehensive-type coverage AND PROVIDES COVERAGE FOR
 PRESCRIPTION DRUGS shall include  coverage  for[,  at  a  minimum,  two]
 medically  necessary epinephrine auto-injector devices for the emergency
 treatment of life-threatening allergic reactions.  Such coverage may  be
 subject  to  annual deductibles and coinsurance  as may be deemed appro-
 priate by the superintendent [and as are consistent with those    estab-
 lished for other benefits within a given policy]; provided  however, the
 total  amount that [a covered person] AN INSURED is required to pay out-
 of-pocket for such devices shall be capped at an amount  not  to  exceed
 one  hundred  dollars annually regardless   of the insured's deductible,
 copayment, coinsurance or any other cost-sharing requirement.  If  under
 federal   law,   application  of [this requirement] THE ANNUAL CAP would
 result in health savings account ineligibility under 26 USC  223,  [this
 requirement  shall  apply  for  health  savings   account-qualified high
 deductible health plans with  respect to the deductible of such  a  plan

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD02836-01-5
 S. 760                              2

 after  the enrollee has satisfied  the  minimum deductible under 26  USC
 223] SUCH COVERAGE MAY BE  SUBJECT  TO  THE  PLAN'S  ANNUAL  DEDUCTIBLE,
 except    for   with   respect to items or  services that are preventive
 care  pursuant  to 26   USC  223(c)(2)(C),  in  which  case the require-
 ments of this paragraph shall apply regardless of   whether the  minimum
 deductible under 26 USC 223 has been satisfied.
   §  2.  Subparagraph  (A)  of paragraph 23 of subsection (k) of section
 3221 of the insurance law, as added by a chapter of  the  laws  of  2024
 amending  the insurance law relating to requiring health insurance plans
 to provide coverage for epinephrine auto-injector devices,  as  proposed
 in legislative bills numbers S. 7114-A and A. 6425-A, is amended to read
 as follows:
   (A)  Every  group  or  blanket policy of accident and health insurance
 delivered or issued for delivery in this state which  provides  [medical
 coverage  that includes coverage for physician services in a physician's
 office and every policy which provides] major medical or similar compre-
 hensive-type coverage AND PROVIDES COVERAGE FOR PRESCRIPTION DRUGS shall
 provide coverage for[, at a minimum, two] medically  necessary  epineph-
 rine auto-injector devices for the emergency treatment of life-threaten-
 ing  allergic reactions.  Such coverage may be subject to annual deduct-
 ibles and coinsurance as may be deemed appropriate by the superintendent
 [and as are consistent with those  established for other benefits within
 a given policy]; provided however, the  total  amount  that  [a  covered
 person]  AN  INSURED  is  required to pay out-of-pocket for such devices
 shall be capped at an amount not to exceed one hundred dollars  annually
 regardless    of the insured's deductible, copayment, coinsurance or any
 other cost-sharing requirement.  If under   federal   law,   application
 of    [this  requirement]  THE ANNUAL CAP would result in health savings
 account ineligibility under 26   USC   223,   [this requirement    shall
 apply     for     health     savings account-qualified high   deductible
 health  plans  with  respect to the  deductible of such a plan after the
 enrollee has satisfied  the  minimum deductible   under 26   USC    223]
 SUCH  COVERAGE  MAY  BE SUBJECT TO THE PLAN'S ANNUAL DEDUCTIBLE,  except
 for  with  respect to items or  services that are preventive care pursu-
 ant to 26  USC  223(c)(2)(C), in which case  the  requirements  of  this
 paragraph  shall  apply  regardless  of   whether the minimum deductible
 under 26 USC 223 has been satisfied.
   § 3. Paragraph 1 of subsection (vv) of section 4303 of  the  insurance
 law,  as  added  by a chapter of the laws of 2024 amending the insurance
 law relating to requiring health insurance plans to provide coverage for
 epinephrine auto-injector devices,  as  proposed  in  legislative  bills
 numbers S. 7114-A and A. 6425-A, is amended to read as follows:
   (1)  Every  medical  expense  indemnity  corporation, hospital service
 corporation and  health  service  corporation  which  provides  [medical
 coverage  that includes coverage for physician services in a physician's
 office and every policy which provides] major medical or similar compre-
 hensive-type coverage AND PROVIDES COVERAGE FOR PRESCRIPTION DRUGS shall
 provide coverage for[, at a minimum, two] medically  necessary  epineph-
 rine auto-injector devices for the emergency treatment of life-threaten-
 ing  allergic reactions.  Such coverage may be subject to annual deduct-
 ibles  and  coinsurance     as  may  be  deemed   appropriate   by   the
 superintendent  [and  as are consistent with those established for other
 benefits within a given policy]; provided however, the total amount that
 [a covered person] AN INSURED is required to pay out-of-pocket for  such
 devices  shall  be capped at an amount not to exceed one hundred dollars
 annually regardless  of the insured's deductible, copayment, coinsurance
 S. 760                              3
 
 or any other cost-sharing requirement. If under  federal  law,  applica-
 tion  of  [this   requirement] THE ANNUAL CAP  would  result  in  health
 savings  account  ineligibility  under 26   USC   223, [this requirement
 shall    apply    for   health   savings account-qualified high  deduct-
 ible  health  plans  with   respect to the deductible  of  such  a  plan
 after  the  enrollee has satisfied   the   minimum  deductible  under 26
 USC  223] SUCH COVERAGE MAY BE SUBJECT TO THE PLAN'S ANNUAL  DEDUCTIBLE,
 except  for  with  respect to items or services that are preventive care
 pursuant  to 26   USC   223(c)(2)(C), in which  case the requirements of
 this paragraph shall apply regardless of whether the minimum  deductible
 under 26 USC 223 has been satisfied.
   §  4.  This  act  shall  take  effect on the same date and in the same
 manner as a chapter of the laws  of  2024  amending  the  insurance  law
 relating  to  requiring  health  insurance plans to provide coverage for
 epinephrine auto-injector devices,  as  proposed  in  legislative  bills
 numbers S. 7114-A and A. 6425-A, takes effect.