A 2443: Clarifies coverage requirements for epinephrine auto-injectors; specifies that such coverage may be subject to the plan's annual deductible.

  
  STATE OF NEW YORK ________________________________________________________________________ 2443 2025-2026 Regular Sessions  IN ASSEMBLY January 17, 2025 ___________ Introduced by M. of A. YEGER -- read once and referred to the Committee on Insurance 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: 1 Section 1. Subparagraph (A) of paragraph 39 of subsection (i) of 2 section 3216 of the insurance law, as added by a chapter of the laws of 3 2024 amending the insurance law relating to requiring health insurance 4 plans to provide coverage for epinephrine auto-injector devices, as 5 proposed in legislative bills numbers S. 7114-A and A. 6425-A, is 6 amended to read as follows: 7 (A) Every insurer issuing a policy of accident and health insurance 8 delivered or issued for delivery in this state which provides major 9 medical or similar comprehensive-type coverage and provides coverage for 10 prescription drugs shall include coverage for[, at a minimum, two] 11 medically necessary epinephrine auto-injector devices for the emergency 12 treatment of life-threatening allergic reactions. Such coverage may be 13 subject to annual deductibles and coinsurance as may be deemed appro- 14 priate by the superintendent [and as are consistent with those estab- 15 lished for other benefits within a given policy]; provided however, the 16 total amount that [a covered person] an insured is required to pay out- 17 of-pocket for such devices shall be capped at an amount not to exceed 18 one hundred dollars annually regardless of the insured's deductible, 19 copayment, coinsurance or any other cost-sharing requirement. If under 20 federal law, application of [this requirement] the annual cap would 21 result in health savings account ineligibility under 26 USC 223, [this 22 requirement shall apply for health savings account-qualified high 23 deductible health plans with respect to the deductible of such a plan 24 after the enrollee has satisfied the minimum deductible under 26 USC EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02836-01-5 
 A. 2443 2 1 223] such coverage may be subject to the plan's annual deductible, 2 except for with respect to items or services that are preventive 3 care pursuant to 26 USC 223(c)(2)(C), in which case the require- 4 ments of this paragraph shall apply regardless of whether the minimum 5 deductible under 26 USC 223 has been satisfied. 6 § 2. Subparagraph (A) of paragraph 23 of subsection (k) of section 7 3221 of the insurance law, as added by a chapter of the laws of 2024 8 amending the insurance law relating to requiring health insurance plans 9 to provide coverage for epinephrine auto-injector devices, as proposed 10 in legislative bills numbers S. 7114-A and A. 6425-A, is amended to read 11 as follows: 12 (A) Every group or blanket policy of accident and health insurance 13 delivered or issued for delivery in this state which provides [medical 14 coverage that includes coverage for physician services in a physician's 15 office and every policy which provides] major medical or similar compre- 16 hensive-type coverage and provides coverage for prescription drugs shall 17 provide coverage for[, at a minimum, two] medically necessary epineph- 18 rine auto-injector devices for the emergency treatment of life-threaten- 19 ing allergic reactions. Such coverage may be subject to annual deduct- 20 ibles and coinsurance as may be deemed appropriate by the superintendent 21 [and as are consistent with those established for other benefits within 22 a given policy]; provided however, the total amount that [a covered 23 person] an insured is required to pay out-of-pocket for such devices 24 shall be capped at an amount not to exceed one hundred dollars annually 25 regardless of the insured's deductible, copayment, coinsurance or any 26 other cost-sharing requirement. If under federal law, application 27 of [this requirement] the annual cap would result in health savings 28 account ineligibility under 26 USC 223, [this requirement shall 29 apply for health savings account-qualified high deductible 30 health plans with respect to the deductible of such a plan after the 31 enrollee has satisfied the minimum deductible under 26 USC 223] 32 such coverage may be subject to the plan's annual deductible, except 33 for with respect to items or services that are preventive care pursu- 34 ant to 26 USC 223(c)(2)(C), in which case the requirements of this 35 paragraph shall apply regardless of whether the minimum deductible 36 under 26 USC 223 has been satisfied. 37 § 3. Paragraph 1 of subsection (vv) of section 4303 of the insurance 38 law, as added by a chapter of the laws of 2024 amending the insurance 39 law relating to requiring health insurance plans to provide coverage for 40 epinephrine auto-injector devices, as proposed in legislative bills 41 numbers S. 7114-A and A. 6425-A, is amended to read as follows: 42 (1) Every medical expense indemnity corporation, hospital service 43 corporation and health service corporation which provides [medical 44 coverage that includes coverage for physician services in a physician's 45 office and every policy which provides] major medical or similar compre- 46 hensive-type coverage and provides coverage for prescription drugs shall 47 provide coverage for[, at a minimum, two] medically necessary epineph- 48 rine auto-injector devices for the emergency treatment of life-threaten- 49 ing allergic reactions. Such coverage may be subject to annual deduct- 50 ibles and coinsurance as may be deemed appropriate by the 51 superintendent [and as are consistent with those established for other 52 benefits within a given policy]; provided however, the total amount that 53 [a covered person] an insured is required to pay out-of-pocket for such 54 devices shall be capped at an amount not to exceed one hundred dollars 55 annually regardless of the insured's deductible, copayment, coinsurance 56 or any other cost-sharing requirement. If under federal law, applica- 
 A. 2443 3 1 tion of [this requirement] the annual cap would result in health 2 savings account ineligibility under 26 USC 223, [this requirement 3 shall apply for health savings account-qualified high deduct- 4 ible health plans with respect to the deductible of such a plan 5 after the enrollee has satisfied the minimum deductible under 26 6 USC 223] such coverage may be subject to the plan's annual deductible, 7 except for with respect to items or services that are preventive care 8 pursuant to 26 USC 223(c)(2)(C), in which case the requirements of 9 this paragraph shall apply regardless of whether the minimum deductible 10 under 26 USC 223 has been satisfied. 11 § 4. This act shall take effect on the same date and in the same 12 manner as a chapter of the laws of 2024 amending the insurance law 13 relating to requiring health insurance plans to provide coverage for 14 epinephrine auto-injector devices, as proposed in legislative bills 15 numbers S. 7114-A and A. 6425-A, takes effect.