S T A T E O F N E W Y O R K
________________________________________________________________________
2841
2013-2014 Regular Sessions
I N S E N A T E
January 24, 2013
___________
Introduced by Sen. PARKER -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to requiring coverage
under the Healthy New York program for mental illness
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. The opening paragraph of subparagraph (A) of paragraph 5 of
subsection (l) of section 3221 of the insurance law, as amended by chap-
ter 502 of the laws of 2007, is amended to read as follows:
Every insurer delivering a group or school blanket policy OR A GROUP
OR INDIVIDUAL POLICY PURSUANT TO SECTION FOUR THOUSAND THREE HUNDRED
TWENTY-SIX OF THIS CHAPTER or issuing a group or school blanket policy
OR A GROUP OR INDIVIDUAL POLICY PURSUANT TO SECTION FOUR THOUSAND THREE
HUNDRED TWENTY-SIX OF THIS CHAPTER for delivery, in this state, which
provides coverage for inpatient hospital care or coverage for physician
services shall provide as part of such policy broad-based coverage for
the diagnosis and treatment of mental, nervous or emotional disorders or
ailments, however defined in such policy, at least equal to the coverage
provided for other health conditions and:
S 2. Item (i) of subparagraph (B) of paragraph 5 of subsection (l) of
section 3221 of the insurance law, as amended by chapter 502 of the laws
of 2007, is amended to read as follows:
(i) Every insurer delivering a group or school blanket policy OR A
GROUP OR INDIVIDUAL POLICY PURSUANT TO SECTION FOUR THOUSAND THREE
HUNDRED TWENTY-SIX OF THIS CHAPTER or issuing a group or school blanket
policy OR A GROUP OR INDIVIDUAL POLICY PURSUANT TO SECTION FOUR THOUSAND
THREE HUNDRED TWENTY-SIX OF THIS CHAPTER for delivery, in this state,
which provides coverage for inpatient hospital care or coverage for
physician services, shall provide comparable coverage for adults and
children with biologically based mental illness. Such group policies
issued or delivered in this state shall also provide such comparable
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD06790-01-3
S. 2841 2
coverage for children with serious emotional disturbances. Such coverage
shall be provided under the terms and conditions otherwise applicable
under the policy, including network limitations or variations, exclu-
sions, co-pays, coinsurance, deductibles or other specific cost sharing
mechanisms. Provided further, where a policy provides both in-network
and out-of-network benefits, the out-of-network benefits may have
different coinsurance, co-pays, or deductibles, than the in-network
benefits, regardless of whether the policy is written under one license
or two licenses.
S 3. Subparagraph (D) of paragraph 5 of subsection (l) of section 3221
of the insurance law, as amended by chapter 502 of the laws of 2007,
item (ii) as amended by section 1 of part A of chapter 503 of the laws
of 2009, is amended to read as follows:
(D) [(i) The provisions of subparagraph (B) of this paragraph shall
not apply to any group purchaser with fifty or fewer employees that is a
policyholder of a policy that is subject to the provisions of this
section; provided however that an insurer must make available, and if
requested by such group purchaser, provide the coverage as specified in
subparagraph (B) of this paragraph. Written notice of the availability
of the coverage shall be delivered to the policyholder prior to incep-
tion of the group policy and annually thereafter.
(ii)] The superintendent shall develop and implement a methodology to
cover the cost to any [such] INDIVIDUAL PURCHASER OR group purchaser
WITH FIFTY OR FEWER EMPLOYEES THAT IS A POLICYHOLDER OF A POLICY THAT IS
SUBJECT TO THE PROVISIONS OF THIS SECTION for providing the coverage
required in subparagraph (A) of this paragraph. Such methodology shall
be financed from moneys appropriated from the General Fund that shall be
made available to the superintendent for such purposes, to the extent of
funds available.
S 4. The opening paragraph of paragraph 1 of subsection (g) of section
4303 of the insurance law, as amended by chapter 502 of the laws of
2007, is amended to read as follows:
A hospital service corporation or a health service corporation, which
provides group, group remittance or school blanket coverage OR GROUP OR
INDIVIDUAL COVERAGE PURSUANT TO SECTION FOUR THOUSAND THREE HUNDRED
TWENTY-SIX OF THIS ARTICLE for inpatient hospital care, shall provide as
part of its contract broad-based coverage for the diagnosis and treat-
ment of mental, nervous or emotional disorders or ailments, however
defined in such contract, at least equal to the coverage provided for
other health conditions and shall include:
S 5. Subparagraph (A) of paragraph 2 of subsection (g) of section 4303
of the insurance law, as amended by chapter 502 of the laws of 2007, is
amended to read as follows:
(A) A hospital service corporation or a health service corporation,
which provides group, group remittance or school blanket coverage OR
GROUP OR INDIVIDUAL COVERAGE PURSUANT TO SECTION FOUR THOUSAND THREE
HUNDRED TWENTY-SIX OF THIS ARTICLE for inpatient hospital care, shall
provide comparable coverage for adults and children with biologically
based mental illness. Such hospital service corporation or health
service corporation shall also provide such comparable coverage for
children with serious emotional disturbances. Such coverage shall be
provided under the terms and conditions otherwise applicable under the
contract, including network limitations or variations, exclusions,
co-pays, coinsurance, deductibles or other specific cost sharing mech-
anisms. Provided further, where a contract provides both in-network and
out-of-network benefits, the out-of-network benefits may have different
S. 2841 3
coinsurance, co-pays, or deductibles, than the in-network benefits,
regardless of whether the contract is written under one license or two
licenses.
S 6. Paragraph 4 of subsection (g) of section 4303 of the insurance
law, as amended by chapter 502 of the laws of 2007, subparagraph (B) as
amended by section 2 of part A of chapter 503 of the laws of 2009, is
amended to read as follows:
(4) [(A) The provisions of paragraph two of this subsection shall not
apply to any group remittance group or group contract holder with fifty
or fewer employees who is a group remittance group or group contract
holder of a policy that is subject to the provisions of this section;
provided however that a hospital service corporation or health service
corporation must make available, and if requested by such group remit-
ting agent or group contract holder, provide the coverage as specified
in paragraph two of this subsection. Written notice of the availability
of such coverage shall be delivered to the remitting agent or group
contract holder prior to inception of such contract and annually there-
after.
(B)] The superintendent shall develop and implement a methodology to
cover the cost to any [such] INDIVIDUAL CONTRACT HOLDER OR group
contract holder WITH FIFTY OR FEWER EMPLOYEES THAT IS A GROUP REMITTANCE
GROUP OR GROUP CONTRACT HOLDER OF A POLICY THAT IS SUBJECT TO THE
PROVISIONS OF THIS SECTION for providing the coverage required in para-
graph one of this subsection. Such methodology shall be financed from
moneys appropriated from the General Fund that shall be made available
to the superintendent for such purposes, to the extent of funds avail-
able.
S 7. Paragraph 1 of subsection (h) of section 4303 of the insurance
law, as amended by chapter 502 of the laws of 2007, is amended to read
as follows:
(1) A medical expense indemnity corporation or a health service corpo-
ration, which provides group, group remittance or school blanket cover-
age OR GROUP OR INDIVIDUAL COVERAGE PURSUANT TO SECTION FOUR THOUSAND
THREE HUNDRED TWENTY-SIX OF THIS ARTICLE for physician services, shall
provide as part of its contract broad-based coverage for the diagnosis
and treatment of mental, nervous or emotional disorders or ailments,
however defined in such contract, at least equal to the coverage
provided for other health conditions and shall include: benefits for
outpatient care provided by a psychiatrist or psychologist licensed to
practice in this state, a licensed clinical social worker who meets the
requirements of subsection (n) of this section, or a professional corpo-
ration or university faculty practice corporation thereof, which bene-
fits may be limited to not less than twenty visits in any contract year,
plan year or calendar year. Such coverage may be provided on a contract
year, plan year or calendar year basis and shall be consistent with the
provision of other benefits under the contract. Such coverage may be
subject to annual deductibles, co-pays and coinsurance as may be deemed
appropriate by the superintendent and shall be consistent with those
imposed on other benefits under the contract. In the event the group
remittance group or contract holder is provided coverage provided under
this paragraph and under subparagraph (B) of paragraph one of subsection
(g) of this section from the same health service corporation, or under a
contract which is jointly underwritten by two health service corpo-
rations or by a health service corporation and a medical expense indem-
nity corporation, the aggregate of the benefits for out-patient care
obtained under subparagraph (B) of paragraph one of subsection (g) of
S. 2841 4
this section and this paragraph may be limited to not less than twenty
visits in any contract year, plan year or calendar year.
S 8. Subparagraph (A) of paragraph 2 of subsection (h) of section 4303
of the insurance law, as amended by chapter 502 of the laws of 2007, is
amended to read as follows:
(A) A medical expense indemnity corporation or a health service corpo-
ration, which provides group, group remittance or school blanket cover-
age OR GROUP OR INDIVIDUAL COVERAGE PURSUANT TO SECTION FOUR THOUSAND
THREE HUNDRED TWENTY-SIX OF THIS ARTICLE for physician services, shall
provide comparable coverage for adults and children with biologically
based mental illness. Such medical expense indemnity corporation or
health service corporation shall also provide such comparable coverage
for children with serious emotional disturbances. Such coverage shall be
provided under the terms and conditions otherwise applicable under the
contract, including network limitations or variations, exclusions,
co-pays, coinsurance, deductibles or other specific cost sharing mech-
anisms. Provided further, where a contract provides both in-network and
out-of-network benefits, the out-of-network benefits may have different
coinsurance, co-pays, or deductibles, than the in-network benefits,
regardless of whether the contract is written under one license or two
licenses.
S 9. Paragraph 4 of subsection (h) of section 4303 of the insurance
law, as amended by chapter 502 of the laws of 2007, subparagraph (B) as
amended by section 3 of part A of chapter 503 of the laws of 2009, is
amended to read as follows:
(4) [(A) The provisions of paragraph two of this subsection shall not
apply to any group remittance group or group contract holder with fifty
or fewer employees who is a group remittance group or group contract
holder of a contract that is subject to the provisions of this section;
provided, however, that a hospital service corporation or health service
corporation must make available, and if requested by such group remit-
ting agent or group contract holder, provide the coverage as specified
in paragraph two of this subsection. Written notice of the availability
of the coverage shall be delivered to the group remitting agent or group
contract holder prior to inception of such contract and annually there-
after.
(B)] The superintendent shall develop and implement a methodology to
cover the cost to any [such] group remittance group and INDIVIDUAL
CONTRACT HOLDER OR group contract holder WITH FIFTY OR FEWER EMPLOYEES
THAT IS A GROUP REMITTANCE GROUP OR GROUP CONTRACT HOLDER OF A POLICY
THAT IS SUBJECT TO THE PROVISIONS OF THIS SECTION for providing the
coverage required in paragraph one of this subsection. Such methodology
shall be financed from moneys appropriated from the General Fund that
shall be made available to the superintendent for such purposes, to the
extent of funds available.
S 10. This act shall take effect immediately.