S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4211
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 31, 2025
                                ___________
 
 Introduced by M. of A. REYES, BUTTENSCHON, GLICK, SHIMSKY, LAVINE, LUNS-
   FORD,  HEVESI,  SIMON, JACKSON, LUCAS, SAYEGH, ZACCARO, DE LOS SANTOS,
   HYNDMAN -- read once and referred to the Committee on Insurance
 
 AN ACT to amend the social  services  law  and  the  insurance  law,  in
   relation to requiring comprehensive coverage for treatment of obesity

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 2 of section 365-a of the social  services  law
 is amended by adding a new paragraph (nn) to read as follows:
   (NN)  (I) COMPREHENSIVE COVERAGE FOR TREATMENT OF OBESITY, WHICH SHALL
 INCLUDE COVERAGE FOR  PREVENTION  AND  WELLNESS,  NUTRITION  COUNSELING,
 INTENSIVE  BEHAVIORAL THERAPY, BARIATRIC SURGERY, AND FDA-APPROVED ANTI-
 OBESITY MEDICATION. FOR PURPOSES OF THIS PARAGRAPH, "FDA-APPROVED  ANTI-
 OBESITY  MEDICATION"  SHALL  MEAN ANY MEDICATION APPROVED BY THE FEDERAL
 FOOD AND DRUG ADMINISTRATION  WITH  AN  INDICATION  FOR  CHRONIC  WEIGHT
 MANAGEMENT IN PATIENTS WITH OBESITY.
   (II)  COVERAGE  CRITERIA  FOR  FDA-APPROVED  ANTI-OBESITY  MEDICATIONS
 PROVIDED UNDER THIS PARAGRAPH SHALL NOT BE  MORE  RESTRICTIVE  THAN  THE
 FDA-APPROVED INDICATIONS FOR SUCH TREATMENTS.
   (III)  COVERAGE  UNDER  THIS  PARAGRAPH SHALL BE NEITHER DIFFERENT NOR
 SEPARATE FROM COVERAGE FOR ANY OTHER ILLNESS, CONDITION, OR DISORDER FOR
 PURPOSES OF DETERMINING DEDUCTIBLES, LIFETIME DOLLAR  LIMITS,  COPAYMENT
 AND  COINSURANCE  FACTORS,  AND BENEFIT YEAR MAXIMUM FOR DEDUCTIBLES AND
 COPAYMENT AND COINSURANCE FACTORS.
   (IV) NOTHING SHALL PRECLUDE THE UNDERTAKING OF UTILIZATION  MANAGEMENT
 TO  DETERMINE  THE MEDICAL NECESSITY FOR TREATMENT OF OBESITY UNDER THIS
 PARAGRAPH, PROVIDED THAT ALL SUCH APPROPRIATENESS AND MEDICAL  NECESSITY
 DETERMINATIONS  ARE  MADE IN THE SAME MANNER AS THOSE DETERMINATIONS ARE
 MADE FOR THE TREATMENT OF ANY  OTHER  ILLNESS,  CONDITION,  OR  DISORDER
 COVERED BY SUCH POLICY, CONTRACT, OR PLAN.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02785-01-5
 A. 4211                             2
              

 
   (V)  THE DEPARTMENT SHALL PROVIDE NOTICE TO ELIGIBLE PERSONS REGARDING
 THE COVERAGE REQUIRED BY THIS PARAGRAPH. THE NOTICE SHALL BE IN  WRITING
 AND  SHALL BE PROMINENTLY POSITIONED IN ANY LITERATURE OR CORRESPONDENCE
 SENT TO MEMBERS AND SHALL BE TRANSMITTED TO MEMBERS WITHIN THE  CALENDAR
 YEAR  WHEN  ANNUAL INFORMATION IS MADE AVAILABLE TO ELIGIBLE PERSONS, OR
 IN ANY OTHER MAILING OR COMMUNICATION TO ELIGIBLE PERSONS.
   § 2. Subsection (i) of section 3216 of the insurance law is amended by
 adding a new paragraph 40 to read as follows:
   (40) (A) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR  SIMI-
 LAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE COMPREHENSIVE COVERAGE FOR
 TREATMENT  OF  OBESITY,  WHICH SHALL INCLUDE COVERAGE FOR PREVENTION AND
 WELLNESS, NUTRITION COUNSELING, INTENSIVE BEHAVIORAL THERAPY,  BARIATRIC
 SURGERY,  AND FDA-APPROVED ANTI-OBESITY MEDICATION. FOR PURPOSES OF THIS
 PARAGRAPH, "FDA-APPROVED ANTI-OBESITY MEDICATION" SHALL MEAN ANY MEDICA-
 TION APPROVED BY THE FEDERAL FOOD AND DRUG ADMINISTRATION WITH AN  INDI-
 CATION FOR CHRONIC WEIGHT MANAGEMENT IN PATIENTS WITH OBESITY.
   (B)   COVERAGE  CRITERIA  FOR  FDA-APPROVED  ANTI-OBESITY  MEDICATIONS
 PROVIDED UNDER THIS PARAGRAPH SHALL NOT BE  MORE  RESTRICTIVE  THAN  THE
 FDA-APPROVED INDICATIONS FOR THOSE TREATMENTS.
   (C) COVERAGE UNDER THIS PARAGRAPH SHALL NEITHER BE DIFFERENT NOR SEPA-
 RATE  FROM  COVERAGE  FOR  ANY OTHER ILLNESS, CONDITION, OR DISORDER FOR
 PURPOSES OF DETERMINING DEDUCTIBLES, LIFETIME DOLLAR  LIMITS,  COPAYMENT
 AND  COINSURANCE  FACTORS,  AND BENEFIT YEAR MAXIMUM FOR DEDUCTIBLES AND
 COPAYMENT AND COINSURANCE FACTORS.
   (D) NOTHING SHALL PRECLUDE THE UNDERTAKING OF  UTILIZATION  MANAGEMENT
 TO  DETERMINE  THE MEDICAL NECESSITY FOR TREATMENT OF OBESITY UNDER THIS
 PARAGRAPH, PROVIDED THAT ALL SUCH APPROPRIATENESS AND MEDICAL  NECESSITY
 DETERMINATIONS  ARE  MADE IN THE SAME MANNER AS THOSE DETERMINATIONS ARE
 MADE FOR THE TREATMENT OF ANY  OTHER  ILLNESS,  CONDITION,  OR  DISORDER
 COVERED BY SUCH POLICY, CONTRACT, OR PLAN.
   (E)  THE INSURER SHALL PROVIDE NOTICE TO COVERED PERSONS REGARDING THE
 COVERAGE REQUIRED BY THIS PARAGRAPH. THE NOTICE SHALL BE IN WRITING  AND
 SHALL BE PROMINENTLY POSITIONED IN ANY LITERATURE OR CORRESPONDENCE SENT
 TO  MEMBERS AND SHALL BE TRANSMITTED TO MEMBERS WITHIN THE CALENDAR YEAR
 WHEN ANNUAL INFORMATION IS MADE AVAILABLE TO COVERED PERSONS, OR IN  ANY
 OTHER MAILING OR COMMUNICATION TO COVERED PERSONS.
   § 3. Subsection (l) of section 3221 of the insurance law is amended by
 adding a new paragraph 23 to read as follows:
   (23) (A) EVERY INSURER DELIVERING A GROUP OR BLANKET POLICY FOR DELIV-
 ERY  IN  THIS  STATE  THAT  PROVIDES  MEDICAL, MAJOR MEDICAL, OR SIMILAR
 COMPREHENSIVE-TYPE COVERAGE SHALL  PROVIDE  COMPREHENSIVE  COVERAGE  FOR
 TREATMENT  OF  OBESITY,  WHICH SHALL INCLUDE COVERAGE FOR PREVENTION AND
 WELLNESS, NUTRITION COUNSELING, INTENSIVE BEHAVIORAL THERAPY,  BARIATRIC
 SURGERY,  AND FDA-APPROVED ANTI-OBESITY MEDICATION. FOR PURPOSES OF THIS
 PARAGRAPH, "FDA-APPROVED ANTI-OBESITY MEDICATION" SHALL MEAN ANY MEDICA-
 TION APPROVED BY THE FEDERAL FOOD AND DRUG ADMINISTRATION WITH AN  INDI-
 CATION FOR CHRONIC WEIGHT MANAGEMENT IN PATIENTS WITH OBESITY.
   (B)   COVERAGE  CRITERIA  FOR  FDA-APPROVED  ANTI-OBESITY  MEDICATIONS
 PROVIDED UNDER THIS PARAGRAPH SHALL NOT BE  MORE  RESTRICTIVE  THAN  THE
 FDA-APPROVED INDICATIONS FOR THOSE TREATMENTS.
   (C) COVERAGE UNDER THIS PARAGRAPH SHALL NEITHER BE DIFFERENT NOR SEPA-
 RATE  FROM  COVERAGE  FOR  ANY OTHER ILLNESS, CONDITION, OR DISORDER FOR
 PURPOSES OF DETERMINING DEDUCTIBLES, LIFETIME DOLLAR  LIMITS,  COPAYMENT
 AND  COINSURANCE  FACTORS,  AND BENEFIT YEAR MAXIMUM FOR DEDUCTIBLES AND
 COPAYMENT AND COINSURANCE FACTORS.
 A. 4211                             3
 
   (D) NOTHING SHALL PRECLUDE THE UNDERTAKING OF  UTILIZATION  MANAGEMENT
 TO  DETERMINE  THE MEDICAL NECESSITY FOR TREATMENT OF OBESITY UNDER THIS
 PARAGRAPH, PROVIDED THAT ALL SUCH APPROPRIATENESS AND MEDICAL  NECESSITY
 DETERMINATIONS  ARE  MADE IN THE SAME MANNER AS THOSE DETERMINATIONS ARE
 MADE  FOR  THE  TREATMENT  OF  ANY OTHER ILLNESS, CONDITION, OR DISORDER
 COVERED BY SUCH POLICY, CONTRACT, OR PLAN.
   (E) THE INSURER SHALL PROVIDE NOTICE TO COVERED PERSONS REGARDING  THE
 COVERAGE  REQUIRED BY THIS PARAGRAPH. THE NOTICE SHALL BE IN WRITING AND
 SHALL BE PROMINENTLY POSITIONED IN ANY LITERATURE OR CORRESPONDENCE SENT
 TO MEMBERS AND SHALL BE TRANSMITTED TO MEMBERS WITHIN THE CALENDAR  YEAR
 WHEN  ANNUAL INFORMATION IS MADE AVAILABLE TO COVERED PERSONS, OR IN ANY
 OTHER MAILING OR COMMUNICATION TO COVERED PERSONS.
   § 4. Section 4303 of the insurance law is  amended  by  adding  a  new
 subsection (ww) to read as follows:
   (WW)  (1) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMI-
 LAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE COMPREHENSIVE COVERAGE FOR
 TREATMENT OF OBESITY, WHICH SHALL INCLUDE COVERAGE  FOR  PREVENTION  AND
 WELLNESS,  NUTRITION COUNSELING, INTENSIVE BEHAVIORAL THERAPY, BARIATRIC
 SURGERY, AND FDA-APPROVED ANTI-OBESITY MEDICATION. FOR PURPOSES OF  THIS
 SUBSECTION,  "FDA-APPROVED ANTI-OBESITY MEDICATION" SHALL MEAN ANY MEDI-
 CATION APPROVED BY THE FEDERAL FOOD  AND  DRUG  ADMINISTRATION  WITH  AN
 INDICATION FOR CHRONIC WEIGHT MANAGEMENT IN PATIENTS WITH OBESITY.
   (2)   COVERAGE  CRITERIA  FOR  FDA-APPROVED  ANTI-OBESITY  MEDICATIONS
 PROVIDED UNDER THIS SUBSECTION SHALL NOT BE MORE  RESTRICTIVE  THAN  THE
 FDA-APPROVED INDICATIONS FOR THOSE TREATMENTS.
   (3)  COVERAGE  UNDER  THIS  SUBSECTION  SHALL NEITHER BE DIFFERENT NOR
 SEPARATE FROM COVERAGE FOR ANY OTHER ILLNESS, CONDITION, OR DISORDER FOR
 PURPOSES OF DETERMINING DEDUCTIBLES, LIFETIME DOLLAR  LIMITS,  COPAYMENT
 AND  COINSURANCE  FACTORS,  AND BENEFIT YEAR MAXIMUM FOR DEDUCTIBLES AND
 COPAYMENT AND COINSURANCE FACTORS.
   (4) NOTHING SHALL PRECLUDE THE UNDERTAKING OF  UTILIZATION  MANAGEMENT
 TO  DETERMINE  THE MEDICAL NECESSITY FOR TREATMENT OF OBESITY UNDER THIS
 SUBSECTION, PROVIDED THAT ALL SUCH APPROPRIATENESS AND MEDICAL NECESSITY
 DETERMINATIONS ARE MADE IN THE SAME MANNER AS THOSE  DETERMINATIONS  ARE
 MADE  FOR  THE  TREATMENT  OF  ANY OTHER ILLNESS, CONDITION, OR DISORDER
 COVERED BY SUCH POLICY, CONTRACT, OR PLAN.
   (5) THE INSURER SHALL PROVIDE NOTICE TO COVERED PERSONS REGARDING  THE
 COVERAGE REQUIRED BY THIS SUBSECTION. THE NOTICE SHALL BE IN WRITING AND
 SHALL BE PROMINENTLY POSITIONED IN ANY LITERATURE OR CORRESPONDENCE SENT
 TO  MEMBERS AND SHALL BE TRANSMITTED TO MEMBERS WITHIN THE CALENDAR YEAR
 WHEN ANNUAL INFORMATION IS MADE AVAILABLE TO COVERED PERSONS, OR IN  ANY
 OTHER MAILING OR COMMUNICATION TO COVERED PERSONS.
   § 5. This act shall take effect on the one hundred eightieth day after
 it  shall have become a law and shall apply to any policy issued, deliv-
 ered, renewed, and/or modified on or after the effective  date  of  this
 act.