S 8326: Expands coverage for developmentally disabled persons past twenty-six years of age; prohibits insurance companies from wrongfully terminating contracts of developmentally disabled persons; requires recertification of such developmentally disabled person's condition once every five years.

  
  STATE OF NEW YORK ________________________________________________________________________ 8326 2025-2026 Regular Sessions  IN SENATE June 2, 2025 ___________ Introduced by Sen. SKOUFIS -- 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 contracts provide coverage to developmentally disabled persons beyond twenty-six years of age The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subparagraph (C) of paragraph 4 of subsection (a) of 2 section 3216 of the insurance law, as amended by chapter 219 of the laws 3 of 2011, is amended to read as follows: 4 (C) In addition to the requirements of subparagraphs (A) and (B) of 5 this paragraph, every insurer issuing a policy of hospital, medical, or 6 surgical expense insurance pursuant to this section that provides cover- 7 age for dependent children must make available and, if requested by the 8 policyholder, extend coverage under the policy to an unmarried child 9 through age twenty-nine, without regard to financial dependence who is 10 not insured by or eligible for coverage under an employer health benefit 11 plan as an employee or member, whether insured or self-insured, and who 12 lives, works or resides in New York state or the service area of the 13 insurer. Such coverage shall be made available at the inception of all 14 new policies. Written notice of the availability of such coverage shall 15 be delivered to the policyholder [thirty days] six months prior to the 16 inception of such policy. Where an unmarried dependent child is incapa- 17 ble of self-sustaining employment by reason of mental illness, or devel- 18 opmental disability as defined in the mental hygiene law, or physical 19 handicap and who became so incapable prior to the age at which dependent 20 coverage would otherwise terminate such coverage shall be extended 21 indefinitely past age twenty-six. 22 § 2. Subparagraph (B) of paragraph 5 of subsection (c) of section 3216 23 of the insurance law, as amended by chapter 479 of the laws of 2022, is 24 amended to read as follows: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD10447-01-5 
 S. 8326 2 1 (B) Written notice of entitlement to a conversion policy shall be 2 given by the insurer to the policyholder at least [fifteen and not more 3 than sixty days] six months prior to the termination of coverage due to 4 the initial limiting age of the covered dependent. Such notice shall 5 include an explanation of the rights of the dependent with respect to 6 the dependent being enrolled in an accredited institution of learning or 7 [his or her] such dependent's incapacity for self-sustaining employment 8 by reason of mental illness, developmental disability as defined in the 9 mental hygiene law or physical [handicap] disability. 10 § 3. The insurance law is amended by adding a new section 3246 to read 11 as follows: 12 § 3246. Certain individual accident and health insurance policy 13 provisions for developmentally disabled persons. 1. Any corporation 14 subject to the provisions of this article offering any individual policy 15 or contract covering the kind or kinds of insurance for an unmarried 16 dependent child who is incapable of self-sustaining employment by reason 17 of mental illness, or developmental disability as defined in the mental 18 hygiene law, or physical disability and who became so incapable prior to 19 the age at which dependent coverage would otherwise terminate shall be 20 prohibited from terminating coverage based on age, employment, or mari- 21 tal status if such dependent child is unmarried. 22 2. If the superintendent finds, after notice and hearing, that an 23 insurer has knowingly and wrongfully violated the provisions of this 24 section, the superintendent may impose a civil penalty of not more than 25 ten thousand dollars for each violation. 26 § 4. The insurance law is amended by adding a new section 3247 to read 27 as follows: 28 § 3247. Recertification of a developmentally disabled person's condi- 29 tion. No corporation subject to the provisions of this article offering 30 an individual policy or contract covering the kind or kinds of insurance 31 for an unmarried dependent child who is incapable of self-sustaining 32 employment by reason of mental illness, or developmental disability as 33 defined in the mental hygiene law, or physical disability and who became 34 so incapable prior to the age at which dependent coverage would other- 35 wise terminate shall request recertification of an unmarried dependent 36 child's condition more than once every five years, unless a substantial 37 change in an unmarried dependent child's condition occurs. 38 § 5. Paragraph 3 of subsection (d) of section 4304 of the insurance 39 law, as amended by chapter 479 of the laws of 2022, is amended to read 40 as follows: 41 (3) Coverage of an unmarried dependent child who is incapable of self- 42 sustaining employment by reason of mental illness, developmental disa- 43 bility, as defined in the mental hygiene law, or physical [handicap] 44 disability and who became so incapable prior to attainment of the age at 45 which coverage would otherwise terminate and who is chiefly dependent 46 upon the contract holder for support and maintenance, shall not termi- 47 nate while the contract remains in force and the child remains in such 48 condition, if the contract holder has within thirty-one days of such 49 child's attainment of the limiting age submitted proof of such child's 50 incapacity as described herein. A contract holder shall be provided six 51 months' notice advising such contract holder that coverage would other- 52 wise terminate if no such proof of a child's incapacity is submitted. 53 § 6. Item (ii) of subparagraph (A) of paragraph 1 of subsection (c) of 54 section 4305 of the insurance law, as amended by chapter 479 of the laws 55 of 2022, is amended to read as follows: 
 S. 8326 3 1 (ii) a contract under which coverage terminates at a specified age 2 shall, with respect to an unmarried child who is incapable of self-sus- 3 taining employment by reason of mental illness, developmental disabili- 4 ty, as defined in the mental hygiene law, or physical [handicap] disa- 5 bility and who became so incapable prior to attainment of the age at 6 which coverage would otherwise terminate and who is chiefly dependent 7 upon such member for support and maintenance, not so terminate while the 8 contract remains in force and the child remains in such condition, if 9 the member has within thirty-one days of such child's attainment of the 10 termination age submitted proof of such child's incapacity as described 11 herein. A contract holder shall be provided six months' notice advising 12 such contract holder that coverage would otherwise terminate if no such 13 proof of a child's incapacity is submitted. 14 § 7. The insurance law is amended by adding a new section 4331 to read 15 as follows: 16 § 4331. Certain individual and group contracts health insurance policy 17 provisions for developmentally disabled persons. 1. Any corporation 18 subject to the provisions of this article offering any policy or 19 contract covering the kind or kinds of insurance for an unmarried 20 dependent child who is incapable of self-sustaining employment by reason 21 of mental illness, or developmental disability as defined in the mental 22 hygiene law, or physical disability and who became so incapable prior to 23 the age at which dependent coverage would otherwise terminate shall be 24 prohibited from terminating coverage based on age, employment, or mari- 25 tal status if such dependent child is unmarried. 26 2. If the superintendent finds, after notice and hearing, that an 27 insurer has knowingly and wrongfully violated the provisions of this 28 section, the superintendent may impose a civil penalty of not more than 29 ten thousand dollars for each violation. 30 § 8. The insurance law is amended by adding a new section 4332 to read 31 as follows: 32 § 4332. Recertification of a developmentally disabled person's condi- 33 tion. No corporation subject to the provisions of this article offering 34 an individual policy or contract covering the kind or kinds of insurance 35 for an unmarried dependent child who is incapable of self-sustaining 36 employment by reason of mental illness, or developmental disability as 37 defined in the mental hygiene law, or physical disability and who became 38 so incapable prior to the age at which dependent coverage would other- 39 wise terminate shall request recertification of an unmarried dependent 40 child's condition more than once every five years, unless a substantial 41 change in an unmarried dependent child's condition occurs. 42 § 9. This act shall take effect January 1, 2026 and shall apply to 43 policies and contracts issued, renewed, modified, altered or amended on 44 or after such date.