A 5939: Relates to coverage of primary and preventive obstetric and gynecological care.

  
  STATE OF NEW YORK ________________________________________________________________________ 5939 2025-2026 Regular Sessions  IN ASSEMBLY February 25, 2025 ___________ Introduced by M. of A. NORBER -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to coverage of primary and preventative obstetric and gynecological care; and repealing certain provisions of such law relating thereto The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subparagraph (E) of paragraph 1 of subsection (p) of 2 section 4303 of the insurance law, as amended by chapter 143 of the laws 3 of 2019, is amended to read as follows: 4 (E) The coverage required in this paragraph or paragraph two of this 5 subsection [shall not] may be subject to annual deductibles or coinsu- 6 rance. 7 § 2. Subparagraph (F) of paragraph 1 of subsection (p) of section 4303 8 of the insurance law, as amended by chapter 424 of the laws of 2024, is 9 amended to read as follows: 10 (F) The coverage required in this paragraph or paragraph two of this 11 subsection [shall not] may be subject to annual deductibles or coinsu- 12 rance. If under federal law, application of this requirement would 13 result in health savings account ineligibility under 26 USC 223, this 14 requirement shall apply for health savings account-qualified high deduc- 15 tible health plans with respect to the deductible of such a plan after 16 the enrollee has satisfied the minimum deductible under 26 USC 223, 17 except for with respect to items or services that are preventive care 18 pursuant to 26 USC 223(c)(2)(C), in which case the requirements of this 19 paragraph shall apply regardless of whether the minimum deductible under 20 26 USC 223 has been satisfied. 21 § 3. Subparagraph (C) of paragraph 14 of subsection (l) of section 22 3221 of the insurance law, as amended by chapter 219 of the laws of 23 2011, is amended to read as follows: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD09796-01-5 
 A. 5939 2 1 (C) Such coverage required pursuant to subparagraph (A) or (B) of this 2 paragraph may not be subject to annual deductibles and coinsurance [as 3 may be deemed appropriate by the superintendent and as are consistent 4 with those established for other benefits within a given policy]. 5 § 4. Paragraph 1 of subsection (t) of section 4303 of the insurance 6 law, as amended by chapter 219 of the laws of 2011, is amended to read 7 as follows: 8 (1) A medical expense indemnity corporation, a hospital service corpo- 9 ration or a health service corporation that provides coverage for hospi- 10 tal, surgical, or medical care shall provide coverage for an annual 11 cervical cytology screening for cervical cancer and its precursor states 12 for [women] people aged eighteen and older who have a cervix. Such 13 coverage required by this paragraph may not be subject to annual deduct- 14 ibles and coinsurance [as may be deemed appropriate by the superinten- 15 dent and as are consistent with those established for other benefits 16 within a given contract]. 17 § 5. The opening paragraph of paragraph 13 of subsection (k) of 18 section 3221 of the insurance law, as amended by chapter 219 of the laws 19 of 2011, is amended to read as follows: 20 Every group or blanket policy delivered or issued for delivery in this 21 state that provides major medical or similar comprehensive-type coverage 22 shall provide such coverage for bone mineral density measurements or 23 tests, and if such contract otherwise includes coverage for prescription 24 drugs, drugs and devices approved by the federal food and drug adminis- 25 tration or generic equivalents as approved substitutes. In determining 26 appropriate coverage provided by subparagraphs (A), (B) and (C) of this 27 paragraph, the insurer or health maintenance organization shall adopt 28 standards that include the criteria of the federal Medicare program and 29 the criteria of the national institutes of health for the detection and 30 treatment of osteoporosis, provided that such coverage shall be further 31 determined as follows: 32 § 6. The opening paragraph of subsection (bb) of section 4303 of the 33 insurance law, as amended by chapter 219 of the laws of 2011, is amended 34 to read as follows: 35 A health service corporation or a medical service expense indemnity 36 corporation that provides major medical or similar comprehensive-type 37 coverage shall provide such coverage for bone mineral density measure- 38 ments or tests, and if such contract otherwise includes coverage for 39 prescription drugs, drugs and devices approved by the federal food and 40 drug administration or generic equivalents as approved substitutes. In 41 determining appropriate coverage provided by paragraphs one, two and 42 three of this subsection, the insurer or health maintenance organization 43 shall adopt standards that include the criteria of the federal Medicare 44 program and the criteria of the national institutes of health for the 45 detection and treatment of osteoporosis, provided that such coverage 46 shall be further determined as follows: 47 § 7. Subsection (cc) of section 4303 of the insurance law is REPEALED 48 and a new subsection (cc) is added to read as follows: 49 (cc) Every contract which provides coverage for prescription drugs 50 shall include coverage for the cost of contraceptive drugs or devices 51 approved by the federal food and drug administration or generic equiv- 52 alents approved as substitutes by such food and drug administration 53 under the prescription of a health care provider legally authorized to 54 prescribe under title eight of the education law. The coverage required 55 by this section shall be included in contracts and certificates only 56 through the addition of a rider. The per member premium rate for cover- 
 A. 5939 3 1 age provided by this rider shall be the same for all contracts and 2 certificates of an insurer or health maintenance organization to which 3 the rider is attached, except that an insurer or health maintenance 4 organization may rate the riders issued with its small group policies 5 separately from the riders issued with its large group contracts. 6 (1) Provided, however, if the group or entity, on whose behalf the 7 contract is issued is operated, supervised or controlled by or in 8 connection with a religious organization or denominational group or 9 entity, then nothing in this subsection shall require the contract to 10 cover any contraceptive drugs or devices that are contrary to the reli- 11 gious tenets of such group or entity. If the insurer or health mainte- 12 nance organization delivering the contract or issuing the contract for 13 delivery in this state is operated, sponsored or controlled by or in 14 connection with a religious organization or denominational group or 15 entity, then nothing in this subsection shall require the contract to 16 cover any contraceptive drugs or devices that are contrary to the reli- 17 gious tenets of such insurer or health maintenance organization. 18 (2)(A) Where a group contractholder makes an election not to purchase 19 coverage for contraceptive drugs or devices in accordance with paragraph 20 one of this subsection, each enrollee covered under the contract issued 21 to that group contractholder shall have the right to directly purchase 22 the rider required by this subsection from the insurer or health mainte- 23 nance organization which issued the group contract. The enrollee's cost 24 of purchasing such rider shall be the same as that which would have been 25 applicable had the group contractholder not exercised such election not 26 to purchase coverage. 27 (B) Where a group contractholder makes an election not to purchase 28 coverage for contraceptive drugs or devices in accordance with paragraph 29 one of this subsection, the insurer or health maintenance organization 30 that provides such coverage shall provide written notice to enrollees 31 upon enrollment with the insurer or health maintenance organization of 32 their right to directly purchase a rider for coverage for the cost of 33 contraceptive drugs or devices. The notice shall also advise the enrol- 34 lees of the additional premium for such coverage. 35 (3) Such coverage may be subject to reasonable annual deductibles and 36 coinsurance as may be deemed appropriate by the superintendent and as 37 are consistent with those established for other drugs or devices covered 38 under the policy. 39 § 8. The second undesignated paragraph of paragraph 26 of subsection 40 (b) of section 4322 of the insurance law, as amended by chapter 219 of 41 the laws of 2011, is amended to read as follows: 42 In determining appropriate coverage provided by subparagraphs (A), (B) 43 and (C) of this paragraph, the insurer or health maintenance organiza- 44 tion shall adopt standards that include the criteria of the federal 45 Medicare program and the criteria of the national institutes of health 46 for the detection and treatment of osteoporosis, provided that such 47 coverage shall be further determined as follows: 48 § 9. Paragraph 16 of subsection (l) of section 3221 of the insurance 49 law is REPEALED and a new paragraph 16 is added to read as follows: 50 (16) Every group or blanket policy which provides coverage for 51 prescription drugs shall include coverage for the cost of contraceptive 52 drugs or devices approved by the federal food and drug administration or 53 generic equivalents approved as substitutes by such food and drug admin- 54 istration under the prescription of a health care provider legally 55 authorized to prescribe under title eight of the education law. The 56 coverage required by this section shall be included in policies and 
 A. 5939 4 1 certificates only through the addition of a rider. The per member premi- 2 um rate for coverage provided by this rider shall be the same for all 3 policies and certificates of an insurer to which the rider is attached, 4 except that an insurer may rate the riders issued with its small group 5 policies separately from the riders issued with its large group poli- 6 cies. 7 (A) Provided, however, if the group or entity, on whose behalf the 8 contract is issued is operated, supervised or controlled by or in 9 connection with a religious organization or denominational group or 10 entity, then nothing in this paragraph shall require the contract to 11 cover any contraceptive drugs or devices that are contrary to the reli- 12 gious tenets of such group or entity. If the insurer or health mainte- 13 nance organization delivering the contract or issuing the contract for 14 delivery in this state is operated, sponsored or controlled by or in 15 connection with a religious organization or denominational group or 16 entity, then nothing in this paragraph shall require the contract to 17 cover any contraceptive drugs or devices that are contrary to the reli- 18 gious tenets of such insurer or health maintenance organization. 19 (B) (i) Where a group policyholder makes an election not to purchase 20 coverage for contraceptive drugs or devices in accordance with subpara- 21 graph (A) of this paragraph each certificateholder covered under the 22 policy issued to that group policyholder shall have the right to direct- 23 ly purchase the rider required by this paragraph from the insurer which 24 issued the group policy. The certificateholder's cost of purchasing such 25 rider shall be the same as that which would have been applicable had the 26 group policyholder not exercised such election not to purchase coverage. 27 (ii) Where a group policyholder makes an election not to purchase 28 coverage for contraceptive drugs or devices in accordance with subpara- 29 graph (A) of this paragraph, the insurer that provides such coverage 30 shall provide written notice to certificateholders upon enrollment with 31 the insurer of their right to directly purchase a rider for coverage for 32 the cost of contraceptive drugs or devices. The notice shall also advise 33 the certificateholders of the additional premium for such coverage. 34 (C) Such coverage may be subject to reasonable annual deductibles and 35 coinsurance as may be deemed appropriate by the superintendent and as 36 are consistent with those established for other drugs or devices covered 37 under the policy. 38 § 10. This act shall take effect on the sixtieth day after it shall 39 have become a law and shall apply to all policies issued, renewed, modi- 40 fied or altered on or after such date; provided, however, that section 41 two of this act shall take effect on the same date and in the same 42 manner as section 5 of chapter 424 of the laws of 2024, takes effect.