S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2443
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 17, 2025
                                ___________
 
 Introduced  by M. of A. YEGER -- read once and referred to the Committee
   on Insurance
 
 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.  Subparagraph  (A)  of  paragraph  39 of subsection (i) of
 section 3216 of the insurance law, as added by a chapter of the laws  of
 2024  amending  the insurance law relating to requiring health insurance
 plans to provide coverage  for  epinephrine  auto-injector  devices,  as
 proposed  in  legislative  bills  numbers  S.  7114-A  and A. 6425-A, is
 amended to read as follows:
   (A) Every insurer issuing a policy of accident  and  health  insurance
 delivered  or  issued  for  delivery  in this state which provides major
 medical or similar comprehensive-type coverage AND PROVIDES COVERAGE FOR
 PRESCRIPTION DRUGS 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 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] AN INSURED 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] THE ANNUAL CAP 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

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02836-01-5
              

 A. 2443                             2

 223] SUCH COVERAGE MAY BE  SUBJECT  TO  THE  PLAN'S  ANNUAL  DEDUCTIBLE,
 except    for   with   respect to items or  services that are preventive
 care pursuant to 26  USC  223(c)(2)(C),  in   which   case the  require-
 ments  of  this paragraph shall apply regardless of  whether the minimum
 deductible under 26 USC 223 has been satisfied.
   § 2. Subparagraph (A) of paragraph 23 of  subsection  (k)  of  section
 3221  of  the  insurance  law, as added by a chapter of the laws of 2024
 amending the insurance law relating to requiring health insurance  plans
 to  provide  coverage for epinephrine auto-injector devices, as proposed
 in legislative bills numbers S. 7114-A and A. 6425-A, is amended to read
 as follows:
   (A) Every group or blanket policy of  accident  and  health  insurance
 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 compre-
 hensive-type coverage AND PROVIDES COVERAGE FOR PRESCRIPTION DRUGS shall
 provide  coverage  for[, at a minimum, two] medically necessary epineph-
 rine auto-injector devices for the emergency treatment of life-threaten-
 ing allergic reactions.  Such coverage may be subject to annual  deduct-
 ibles 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] AN INSURED 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] THE ANNUAL CAP 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]
 SUCH COVERAGE MAY BE SUBJECT TO THE PLAN'S ANNUAL  DEDUCTIBLE,    except
 for  with  respect to items or  services that are preventive care pursu-
 ant  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.
   §  3.  Paragraph 1 of subsection (vv) of section 4303 of the insurance
 law, as added by a chapter of the laws of 2024  amending  the  insurance
 law relating to requiring health insurance plans to provide coverage for
 epinephrine  auto-injector  devices,  as  proposed  in legislative bills
 numbers S. 7114-A and A. 6425-A, is amended to read as follows:
   (1) Every medical  expense  indemnity  corporation,  hospital  service
 corporation  and  health  service  corporation  which  provides [medical
 coverage that includes coverage for physician services in a  physician's
 office and every policy which provides] major medical or similar compre-
 hensive-type coverage AND PROVIDES COVERAGE FOR PRESCRIPTION DRUGS shall
 provide  coverage  for[, at a minimum, two] medically necessary epineph-
 rine auto-injector devices for the emergency treatment of life-threaten-
 ing allergic reactions.  Such coverage may be subject to annual  deduct-
 ibles   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] AN INSURED 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,  applica-
 A. 2443                             3
 
 tion    of    [this   requirement] THE ANNUAL CAP 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] SUCH COVERAGE MAY BE SUBJECT TO THE PLAN'S ANNUAL DEDUCTIBLE,
 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.
   § 4. This act shall take effect on the  same  date  and  in  the  same
 manner  as  a  chapter  of  the  laws of 2024 amending the insurance law
 relating to requiring health insurance plans  to  provide  coverage  for
 epinephrine  auto-injector  devices,  as  proposed  in legislative bills
 numbers S. 7114-A and A. 6425-A, takes effect.