S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1619
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 16, 2019
                                ___________
 
 Introduced  by  M.  of A. ROZIC, BLAKE, BRONSON, COLTON, CRESPO, D'URSO,
   DE LA ROSA, ENGLEBRIGHT, BARRETT,  FAHY,  FERNANDEZ,  GUNTHER,  ORTIZ,
   L. ROSENTHAL,  D. ROSENTHAL,  RIVERA, SIMON, SOLAGES, ABINANTI, JOHNS,
   RAIA -- Multi-Sponsored by -- M. of A. COOK,  CROUCH,  GALEF,  GIGLIO,
   M. L. MILLER,  NOLAN, RA -- read once and referred to the Committee on
   Insurance
 
 AN ACT to amend the insurance law, in relation to  coverage  for  eating
   disorders
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (B)  of  paragraph  5  of  subsection  (1)  of
 section 3221 of the insurance law, as amended by chapter 502 of the laws
 of 2007, is amended to read as follows:
   (B)  (i)  Every insurer delivering a group or school blanket policy or
 issuing a group or school blanket policy 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
 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.
   (ii) For purposes of this  paragraph,  the  term  "biologically  based
 mental  illness" means a mental, nervous, or emotional condition that is
 caused by a biological disorder of the brain and results in a clinically

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD01128-01-9

 A. 1619                             2
 
 significant, psychological syndrome or pattern that substantially limits
 the functioning of the person with the illness. Such biologically  based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression,  bipolar  disorder,  delusional  disorders,  panic disorder,
 obsessive compulsive disorders[, bulimia, and  anorexia]  OR  AN  EATING
 DISORDER.
   (III) FOR PURPOSES OF THIS PARAGRAPH, THE TERM "EATING DISORDER" MEANS
 PICA,  RUMINATION  DISORDER,  AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER,
 ANOREXIA NERVOSA, BULIMIA NERVOSA, BINGE EATING DISORDER,  OTHER  SPECI-
 FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
 IN  THE  MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF
 MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION.
   § 2. 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:
   (2) (A) A hospital service corporation  or  a  health  service  corpo-
 ration,  which provides group, group remittance or school blanket cover-
 age for inpatient hospital care, shall provide comparable  coverage  for
 adults  and children with biologically based mental illness. Such hospi-
 tal service corporation or health service corporation shall also provide
 such comparable coverage for children with  serious  emotional  disturb-
 ances.  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 mechanisms. 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.
   (B)  For  purposes  of  this  subsection, the term "biologically based
 mental illness" means a mental, nervous, or emotional condition that  is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the  functioning of the person with the illness. Such biologically based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression, bipolar  disorder,  delusional  disorders,  panic  disorder,
 obsessive  compulsive  disorders[,  anorexia,  and bulimia] OR AN EATING
 DISORDER.
   (C) FOR PURPOSES OF THIS SUBSECTION, THE TERM "EATING DISORDER"  MEANS
 PICA,  RUMINATION  DISORDER,  AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER,
 ANOREXIA NERVOSA, BULIMIA NERVOSA, BINGE EATING DISORDER,  OTHER  SPECI-
 FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
 IN  THE  MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF
 MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION.
   § 3. 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:
   (2) (A) A medical expense indemnity corporation or  a  health  service
 corporation,  which  provides  group, group remittance or school blanket
 coverage 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 condi-
 tions otherwise applicable under the contract, including network limita-
 tions  or  variations,  exclusions, co-pays, coinsurance, deductibles or

 A. 1619                             3
 
 other specific  cost  sharing  mechanisms.  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  deduct-
 ibles,  than the in-network benefits, regardless of whether the contract
 is written under one license or two licenses.
   (B) For purposes of this  subsection,  the  term  "biologically  based
 mental  illness" means a mental, nervous, or emotional condition that is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the functioning of the person with the illness. Such biologically  based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression,  bipolar  disorder,  delusional  disorders,  panic disorder,
 obsessive compulsive disorder[, anorexia,  and  bulimia]  OR  AN  EATING
 DISORDER.
   (C)  FOR PURPOSES OF THIS SUBSECTION, THE TERM "EATING DISORDER" MEANS
 PICA, RUMINATION DISORDER, AVOIDANT/RESTRICTIVE  FOOD  INTAKE  DISORDER,
 ANOREXIA  NERVOSA,  BULIMIA NERVOSA, BINGE EATING DISORDER, OTHER SPECI-
 FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
 IN THE MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL  MANUAL  OF
 MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION.
   §  4.  This  act shall take effect on the ninetieth day after it shall
 have become a law; provided, however, that the provisions  of  this  act
 shall apply to policies and contracts issued, renewed, modified, altered
 or amended on or after such effective date.