A 4211: Requires comprehensive coverage for treatment of obesity, including coverage for prevention and wellness, nutrition counseling, intensive behavioral therapy, bariatric surgery, and FDA-approved anti-obesity medication.

  
  STATE OF NEW YORK ________________________________________________________________________ 4211 2025-2026 Regular Sessions  IN ASSEMBLY January 31, 2025 ___________ Introduced by M. of A. REYES, BUTTENSCHON, GLICK, SHIMSKY, LAVINE, LUNS- FORD, HEVESI, SIMON, JACKSON, LUCAS, SAYEGH, ZACCARO, DE LOS SANTOS, HYNDMAN -- read once and referred to the Committee on Insurance AN ACT to amend the social services law and the insurance law, in relation to requiring comprehensive coverage for treatment of obesity The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subdivision 2 of section 365-a of the social services law 2 is amended by adding a new paragraph (nn) to read as follows: 3 (nn) (i) Comprehensive coverage for treatment of obesity, which shall 4 include coverage for prevention and wellness, nutrition counseling, 5 intensive behavioral therapy, bariatric surgery, and FDA-approved anti- 6 obesity medication. For purposes of this paragraph, "FDA-approved anti- 7 obesity medication" shall mean any medication approved by the federal 8 food and drug administration with an indication for chronic weight 9 management in patients with obesity. 10 (ii) Coverage criteria for FDA-approved anti-obesity medications 11 provided under this paragraph shall not be more restrictive than the 12 FDA-approved indications for such treatments. 13 (iii) Coverage under this paragraph shall be neither different nor 14 separate from coverage for any other illness, condition, or disorder for 15 purposes of determining deductibles, lifetime dollar limits, copayment 16 and coinsurance factors, and benefit year maximum for deductibles and 17 copayment and coinsurance factors. 18 (iv) Nothing shall preclude the undertaking of utilization management 19 to determine the medical necessity for treatment of obesity under this 20 paragraph, provided that all such appropriateness and medical necessity 21 determinations are made in the same manner as those determinations are 22 made for the treatment of any other illness, condition, or disorder 23 covered by such policy, contract, or plan. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02785-01-5 
 A. 4211 2 1 (v) The department shall provide notice to eligible persons regarding 2 the coverage required by this paragraph. The notice shall be in writing 3 and shall be prominently positioned in any literature or correspondence 4 sent to members and shall be transmitted to members within the calendar 5 year when annual information is made available to eligible persons, or 6 in any other mailing or communication to eligible persons. 7 § 2. Subsection (i) of section 3216 of the insurance law is amended by 8 adding a new paragraph 40 to read as follows: 9 (40) (A) Every policy which provides medical, major medical, or simi- 10 lar comprehensive-type coverage shall provide comprehensive coverage for 11 treatment of obesity, which shall include coverage for prevention and 12 wellness, nutrition counseling, intensive behavioral therapy, bariatric 13 surgery, and FDA-approved anti-obesity medication. For purposes of this 14 paragraph, "FDA-approved anti-obesity medication" shall mean any medica- 15 tion approved by the federal food and drug administration with an indi- 16 cation for chronic weight management in patients with obesity. 17 (B) Coverage criteria for FDA-approved anti-obesity medications 18 provided under this paragraph shall not be more restrictive than the 19 FDA-approved indications for those treatments. 20 (C) Coverage under this paragraph shall neither be different nor sepa- 21 rate from coverage for any other illness, condition, or disorder for 22 purposes of determining deductibles, lifetime dollar limits, copayment 23 and coinsurance factors, and benefit year maximum for deductibles and 24 copayment and coinsurance factors. 25 (D) Nothing shall preclude the undertaking of utilization management 26 to determine the medical necessity for treatment of obesity under this 27 paragraph, provided that all such appropriateness and medical necessity 28 determinations are made in the same manner as those determinations are 29 made for the treatment of any other illness, condition, or disorder 30 covered by such policy, contract, or plan. 31 (E) The insurer shall provide notice to covered persons regarding the 32 coverage required by this paragraph. The notice shall be in writing and 33 shall be prominently positioned in any literature or correspondence sent 34 to members and shall be transmitted to members within the calendar year 35 when annual information is made available to covered persons, or in any 36 other mailing or communication to covered persons. 37 § 3. Subsection (l) of section 3221 of the insurance law is amended by 38 adding a new paragraph 23 to read as follows: 39 (23) (A) Every insurer delivering a group or blanket policy for deliv- 40 ery in this state that provides medical, major medical, or similar 41 comprehensive-type coverage shall provide comprehensive coverage for 42 treatment of obesity, which shall include coverage for prevention and 43 wellness, nutrition counseling, intensive behavioral therapy, bariatric 44 surgery, and FDA-approved anti-obesity medication. For purposes of this 45 paragraph, "FDA-approved anti-obesity medication" shall mean any medica- 46 tion approved by the federal food and drug administration with an indi- 47 cation for chronic weight management in patients with obesity. 48 (B) Coverage criteria for FDA-approved anti-obesity medications 49 provided under this paragraph shall not be more restrictive than the 50 FDA-approved indications for those treatments. 51 (C) Coverage under this paragraph shall neither be different nor sepa- 52 rate from coverage for any other illness, condition, or disorder for 53 purposes of determining deductibles, lifetime dollar limits, copayment 54 and coinsurance factors, and benefit year maximum for deductibles and 55 copayment and coinsurance factors. 
 A. 4211 3 1 (D) Nothing shall preclude the undertaking of utilization management 2 to determine the medical necessity for treatment of obesity under this 3 paragraph, provided that all such appropriateness and medical necessity 4 determinations are made in the same manner as those determinations are 5 made for the treatment of any other illness, condition, or disorder 6 covered by such policy, contract, or plan. 7 (E) The insurer shall provide notice to covered persons regarding the 8 coverage required by this paragraph. The notice shall be in writing and 9 shall be prominently positioned in any literature or correspondence sent 10 to members and shall be transmitted to members within the calendar year 11 when annual information is made available to covered persons, or in any 12 other mailing or communication to covered persons. 13 § 4. Section 4303 of the insurance law is amended by adding a new 14 subsection (ww) to read as follows: 15 (ww) (1) Every policy which provides medical, major medical, or simi- 16 lar comprehensive-type coverage shall provide comprehensive coverage for 17 treatment of obesity, which shall include coverage for prevention and 18 wellness, nutrition counseling, intensive behavioral therapy, bariatric 19 surgery, and FDA-approved anti-obesity medication. For purposes of this 20 subsection, "FDA-approved anti-obesity medication" shall mean any medi- 21 cation approved by the federal food and drug administration with an 22 indication for chronic weight management in patients with obesity. 23 (2) Coverage criteria for FDA-approved anti-obesity medications 24 provided under this subsection shall not be more restrictive than the 25 FDA-approved indications for those treatments. 26 (3) Coverage under this subsection shall neither be different nor 27 separate from coverage for any other illness, condition, or disorder for 28 purposes of determining deductibles, lifetime dollar limits, copayment 29 and coinsurance factors, and benefit year maximum for deductibles and 30 copayment and coinsurance factors. 31 (4) Nothing shall preclude the undertaking of utilization management 32 to determine the medical necessity for treatment of obesity under this 33 subsection, provided that all such appropriateness and medical necessity 34 determinations are made in the same manner as those determinations are 35 made for the treatment of any other illness, condition, or disorder 36 covered by such policy, contract, or plan. 37 (5) The insurer shall provide notice to covered persons regarding the 38 coverage required by this subsection. The notice shall be in writing and 39 shall be prominently positioned in any literature or correspondence sent 40 to members and shall be transmitted to members within the calendar year 41 when annual information is made available to covered persons, or in any 42 other mailing or communication to covered persons. 43 § 5. This act shall take effect on the one hundred eightieth day after 44 it shall have become a law and shall apply to any policy issued, deliv- 45 ered, renewed, and/or modified on or after the effective date of this 46 act.