S T A T E O F N E W Y O R K
________________________________________________________________________
6425--A
2023-2024 Regular Sessions
I N A S S E M B L Y
April 6, 2023
___________
Introduced by M. of A. O'DONNELL, PAULIN, LUNSFORD, LAVINE, WEPRIN,
SIMON, BURDICK, DAVILA, STERN, SILLITTI, SIMONE, SHIMSKY, DICKENS,
DeSTEFANO, LEMONDES, McDONOUGH, JACOBSON, STECK -- read once and
referred to the Committee on Insurance -- recommitted to the Committee
on Insurance in accordance with Assembly Rule 3, sec. 2 -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
AN ACT to amend the insurance law, in relation to requiring health
insurance plans to provide coverage for epinephrine auto-injector
devices
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subsection (i) of section 3216 of the insurance law is
amended by adding a new paragraph 39 to read as follows:
(39) (A) EVERY INSURER ISSUING A POLICY OF ACCIDENT AND HEALTH INSUR-
ANCE DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE WHICH PROVIDES MAJOR
MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL INCLUDE COVERAGE
FOR, AT A MINIMUM, TWO MEDICALLY NECESSARY EPINEPHRINE AUTO-INJECTOR
DEVICES FOR THE EMERGENCY TREATMENT OF LIFE-THREATENING ALLERGIC
REACTIONS. SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COIN-
SURANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE
CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN
POLICY; PROVIDED HOWEVER, THE TOTAL AMOUNT THAT A COVERED PERSON IS
REQUIRED TO PAY OUT-OF-POCKET FOR SUCH DEVICES SHALL BE CAPPED AT AN
AMOUNT NOT TO EXCEED ONE HUNDRED DOLLARS ANNUALLY REGARDLESS OF THE
INSURED'S DEDUCTIBLE, COPAYMENT, COINSURANCE OR ANY OTHER COST-SHARING
REQUIREMENT. IF UNDER FEDERAL LAW, APPLICATION OF THIS REQUIREMENT
WOULD RESULT IN HEALTH SAVINGS ACCOUNT INELIGIBILITY UNDER 26 USC
223, THIS REQUIREMENT SHALL APPLY FOR HEALTH SAVINGS
ACCOUNT-QUALIFIED HIGH DEDUCTIBLE HEALTH PLANS WITH RESPECT TO THE
DEDUCTIBLE OF SUCH A PLAN AFTER THE ENROLLEE HAS SATISFIED THE MINIMUM
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10597-02-4
A. 6425--A 2
DEDUCTIBLE UNDER 26 USC 223, EXCEPT FOR WITH RESPECT TO ITEMS OR
SERVICES THAT ARE PREVENTIVE CARE PURSUANT TO 26 USC 223(C)(2)(C), IN
WHICH CASE THE REQUIREMENTS OF THIS PARAGRAPH SHALL APPLY REGARDLESS OF
WHETHER THE MINIMUM DEDUCTIBLE UNDER 26 USC 223 HAS BEEN SATISFIED.
(B) FOR THE PURPOSES OF THIS PARAGRAPH, "EPINEPHRINE AUTO-INJECTOR
DEVICE" SHALL HAVE THE SAME MEANING AS PROVIDED IN PARAGRAPH (B) OF
SUBDIVISION ONE OF SECTION THREE THOUSAND-C OF THE PUBLIC HEALTH LAW.
§ 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 23 to read as follows:
(23) (A) EVERY GROUP OR BLANKET POLICY OF ACCIDENT AND HEALTH INSUR-
ANCE DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE WHICH PROVIDES
MEDICAL COVERAGE THAT INCLUDES COVERAGE FOR PHYSICIAN SERVICES IN A
PHYSICIAN'S OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR MEDICAL OR
SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE COVERAGE FOR, AT A
MINIMUM, TWO MEDICALLY NECESSARY EPINEPHRINE AUTO-INJECTOR DEVICES FOR
THE EMERGENCY TREATMENT OF LIFE-THREATENING ALLERGIC REACTIONS. SUCH
COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE AS MAY BE
DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT WITH
THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY; PROVIDED
HOWEVER, THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED TO PAY OUT-
OF-POCKET FOR SUCH DEVICES SHALL BE CAPPED AT AN AMOUNT NOT TO EXCEED
ONE HUNDRED DOLLARS ANNUALLY REGARDLESS OF THE INSURED'S DEDUCTIBLE,
COPAYMENT, COINSURANCE OR ANY OTHER COST-SHARING REQUIREMENT. IF UNDER
FEDERAL LAW, APPLICATION OF THIS REQUIREMENT WOULD RESULT IN HEALTH
SAVINGS ACCOUNT INELIGIBILITY UNDER 26 USC 223, THIS REQUIREMENT
SHALL APPLY FOR HEALTH SAVINGS ACCOUNT-QUALIFIED HIGH DEDUCT-
IBLE HEALTH PLANS WITH RESPECT TO THE DEDUCTIBLE OF SUCH A PLAN
AFTER THE ENROLLEE HAS SATISFIED THE MINIMUM DEDUCTIBLE UNDER 26 USC
223, EXCEPT FOR WITH RESPECT TO ITEMS OR SERVICES THAT ARE PREVEN-
TIVE CARE PURSUANT TO 26 USC 223(C)(2)(C), IN WHICH CASE THE
REQUIREMENTS OF THIS PARAGRAPH SHALL APPLY REGARDLESS OF WHETHER THE
MINIMUM DEDUCTIBLE UNDER 26 USC 223 HAS BEEN SATISFIED.
(B) FOR THE PURPOSES OF THIS PARAGRAPH, "EPINEPHRINE AUTO-INJECTOR
DEVICE" SHALL HAVE THE SAME MEANING AS PROVIDED IN PARAGRAPH (B) OF
SUBDIVISION ONE OF SECTION THREE THOUSAND-C OF THE PUBLIC HEALTH LAW.
§ 3. Section 4303 of the insurance law is amended by adding a new
subsection (vv) to read as follows:
(VV) (1) EVERY MEDICAL EXPENSE INDEMNITY CORPORATION, HOSPITAL SERVICE
CORPORATION AND HEALTH SERVICE CORPORATION WHICH PROVIDES MEDICAL COVER-
AGE THAT INCLUDES COVERAGE FOR PHYSICIAN SERVICES IN A PHYSICIAN'S
OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR MEDICAL OR SIMILAR COMPRE-
HENSIVE-TYPE COVERAGE SHALL PROVIDE COVERAGE FOR, AT A MINIMUM, TWO
MEDICALLY NECESSARY EPINEPHRINE AUTO-INJECTOR DEVICES FOR THE EMERGENCY
TREATMENT OF LIFE-THREATENING ALLERGIC REACTIONS. SUCH COVERAGE MAY BE
SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE AS MAY BE DEEMED APPRO-
PRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT WITH THOSE ESTAB-
LISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY; PROVIDED HOWEVER, THE
TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED TO PAY OUT-OF-POCKET FOR
SUCH DEVICES SHALL BE CAPPED AT AN AMOUNT NOT TO EXCEED ONE HUNDRED
DOLLARS ANNUALLY REGARDLESS OF THE INSURED'S DEDUCTIBLE, COPAYMENT,
COINSURANCE OR ANY OTHER COST-SHARING REQUIREMENT. IF UNDER FEDERAL
LAW, APPLICATION OF THIS REQUIREMENT WOULD RESULT IN HEALTH SAVINGS
ACCOUNT INELIGIBILITY UNDER 26 USC 223, THIS REQUIREMENT SHALL
APPLY FOR HEALTH SAVINGS ACCOUNT-QUALIFIED HIGH DEDUCTIBLE
HEALTH PLANS WITH RESPECT TO THE DEDUCTIBLE OF SUCH A PLAN AFTER THE
ENROLLEE HAS SATISFIED THE MINIMUM DEDUCTIBLE UNDER 26 USC 223,
A. 6425--A 3
EXCEPT FOR WITH RESPECT TO ITEMS OR SERVICES THAT ARE PREVENTIVE CARE
PURSUANT TO 26 USC 223(C)(2)(C), IN WHICH CASE THE REQUIREMENTS OF
THIS PARAGRAPH SHALL APPLY REGARDLESS OF WHETHER THE MINIMUM DEDUCTIBLE
UNDER 26 USC 223 HAS BEEN SATISFIED.
(2) FOR THE PURPOSES OF THIS SUBSECTION, "EPINEPHRINE AUTO-INJECTOR
DEVICE" SHALL HAVE THE SAME MEANING AS PROVIDED IN PARAGRAPH (B) OF
SUBDIVISION ONE OF SECTION THREE THOUSAND-C OF THE PUBLIC HEALTH LAW.
§ 4. This act shall take effect January 1, 2026 and shall apply to all
policies and contracts issued, renewed, modified, altered or amended on
or after such date.