S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5939
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 25, 2025
                                ___________
 
 Introduced by M. of A. NORBER -- read once and referred to the Committee
   on Insurance
 
 AN  ACT  to  amend the insurance law, in relation to coverage of primary
   and preventative  obstetric  and  gynecological  care;  and  repealing
   certain provisions of such law relating thereto

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (E)  of  paragraph  1  of  subsection  (p)  of
 section 4303 of the insurance law, as amended by chapter 143 of the laws
 of 2019, is amended to read as follows:
   (E)  The  coverage required in this paragraph or paragraph two of this
 subsection [shall not] MAY be subject to annual deductibles  or  coinsu-
 rance.
   § 2. Subparagraph (F) of paragraph 1 of subsection (p) of section 4303
 of  the insurance law, as amended by chapter 424 of the laws of 2024, is
 amended to read as follows:
   (F) The coverage required in this paragraph or paragraph two  of  this
 subsection  [shall  not] MAY be subject to annual deductibles or coinsu-
 rance. 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 deduc-
 tible 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  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.
   § 3. Subparagraph (C) of paragraph 14 of  subsection  (l)  of  section
 3221  of  the  insurance  law,  as amended by chapter 219 of the laws of
 2011, is amended to read as follows:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09796-01-5
 A. 5939                             2
              

 
   (C) Such coverage required pursuant to subparagraph (A) or (B) of this
 paragraph may NOT 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].
   §  4.  Paragraph  1 of subsection (t) of section 4303 of the insurance
 law, as amended by chapter 219 of the laws of 2011, is amended  to  read
 as follows:
   (1) A medical expense indemnity corporation, a hospital service corpo-
 ration or a health service corporation that provides coverage for hospi-
 tal,  surgical,  or  medical  care  shall provide coverage for an annual
 cervical cytology screening for cervical cancer and its precursor states
 for [women] PEOPLE aged eighteen and  older  WHO  HAVE  A  CERVIX.  Such
 coverage required by this paragraph may NOT be subject to annual deduct-
 ibles  and  coinsurance [as may be deemed appropriate by the superinten-
 dent and as are consistent with those  established  for  other  benefits
 within a given contract].
   §  5.  The  opening  paragraph  of  paragraph  13 of subsection (k) of
 section 3221 of the insurance law, as amended by chapter 219 of the laws
 of 2011, is amended to read as follows:
   Every group or blanket policy delivered or issued for delivery in this
 state that provides major medical or similar comprehensive-type coverage
 shall provide such coverage for bone  mineral  density  measurements  or
 tests, and if such contract otherwise includes coverage for prescription
 drugs,  drugs and devices approved by the federal food and drug adminis-
 tration or generic equivalents as approved substitutes.  In  determining
 appropriate  coverage provided by subparagraphs (A), (B) and (C) of this
 paragraph, the insurer or health maintenance  organization  shall  adopt
 standards  that include the criteria of the federal Medicare program and
 the criteria of the national institutes of health for the detection  AND
 TREATMENT  of osteoporosis, provided that such coverage shall be further
 determined as follows:
   § 6. The opening paragraph of subsection (bb) of section 4303  of  the
 insurance law, as amended by chapter 219 of the laws of 2011, is amended
 to read as follows:
   A  health  service  corporation or a medical service expense indemnity
 corporation that provides major medical  or  similar  comprehensive-type
 coverage  shall  provide such coverage for bone mineral density measure-
 ments or tests, and if such contract  otherwise  includes  coverage  for
 prescription  drugs,  drugs and devices approved by the federal food and
 drug administration or generic equivalents as approved  substitutes.  In
 determining  appropriate  coverage  provided  by paragraphs one, two and
 three of this subsection, the insurer or health maintenance organization
 shall adopt standards that include the criteria of the federal  Medicare
 program  and  the  criteria of the national institutes of health for the
 detection AND TREATMENT of osteoporosis,  provided  that  such  coverage
 shall be further determined as follows:
   §  7. Subsection (cc) of section 4303 of the insurance law is REPEALED
 and a new subsection (cc) is added to read as follows:
   (CC) EVERY CONTRACT WHICH PROVIDES  COVERAGE  FOR  PRESCRIPTION  DRUGS
 SHALL  INCLUDE  COVERAGE  FOR THE COST OF CONTRACEPTIVE DRUGS OR DEVICES
 APPROVED BY THE FEDERAL FOOD AND DRUG ADMINISTRATION OR  GENERIC  EQUIV-
 ALENTS  APPROVED  AS  SUBSTITUTES  BY  SUCH FOOD AND DRUG ADMINISTRATION
 UNDER THE PRESCRIPTION OF A HEALTH CARE PROVIDER LEGALLY  AUTHORIZED  TO
 PRESCRIBE  UNDER TITLE EIGHT OF THE EDUCATION LAW. THE COVERAGE REQUIRED
 BY THIS SECTION SHALL BE INCLUDED IN  CONTRACTS  AND  CERTIFICATES  ONLY
 THROUGH  THE ADDITION OF A RIDER. THE PER MEMBER PREMIUM RATE FOR COVER-
 A. 5939                             3

 AGE PROVIDED BY THIS RIDER SHALL BE  THE  SAME  FOR  ALL  CONTRACTS  AND
 CERTIFICATES  OF  AN INSURER OR HEALTH MAINTENANCE ORGANIZATION TO WHICH
 THE RIDER IS ATTACHED, EXCEPT THAT  AN  INSURER  OR  HEALTH  MAINTENANCE
 ORGANIZATION  MAY  RATE  THE RIDERS ISSUED WITH ITS SMALL GROUP POLICIES
 SEPARATELY FROM THE RIDERS ISSUED WITH ITS LARGE GROUP CONTRACTS.
   (1) PROVIDED, HOWEVER, IF THE GROUP OR ENTITY,  ON  WHOSE  BEHALF  THE
 CONTRACT  IS  ISSUED  IS  OPERATED,  SUPERVISED  OR  CONTROLLED BY OR IN
 CONNECTION WITH A RELIGIOUS  ORGANIZATION  OR  DENOMINATIONAL  GROUP  OR
 ENTITY,  THEN  NOTHING  IN THIS SUBSECTION SHALL REQUIRE THE CONTRACT TO
 COVER ANY CONTRACEPTIVE DRUGS OR DEVICES THAT ARE CONTRARY TO THE  RELI-
 GIOUS  TENETS  OF SUCH GROUP OR ENTITY. IF THE INSURER OR HEALTH MAINTE-
 NANCE ORGANIZATION DELIVERING THE CONTRACT OR ISSUING THE  CONTRACT  FOR
 DELIVERY  IN  THIS  STATE  IS OPERATED, SPONSORED OR CONTROLLED BY OR IN
 CONNECTION WITH A RELIGIOUS  ORGANIZATION  OR  DENOMINATIONAL  GROUP  OR
 ENTITY,  THEN  NOTHING  IN THIS SUBSECTION SHALL REQUIRE THE CONTRACT TO
 COVER ANY CONTRACEPTIVE DRUGS OR DEVICES THAT ARE CONTRARY TO THE  RELI-
 GIOUS TENETS OF SUCH INSURER OR HEALTH MAINTENANCE ORGANIZATION.
   (2)(A)  WHERE A GROUP CONTRACTHOLDER MAKES AN ELECTION NOT TO PURCHASE
 COVERAGE FOR CONTRACEPTIVE DRUGS OR DEVICES IN ACCORDANCE WITH PARAGRAPH
 ONE OF THIS SUBSECTION, EACH ENROLLEE COVERED UNDER THE CONTRACT  ISSUED
 TO  THAT  GROUP CONTRACTHOLDER SHALL HAVE THE RIGHT TO DIRECTLY PURCHASE
 THE RIDER REQUIRED BY THIS SUBSECTION FROM THE INSURER OR HEALTH MAINTE-
 NANCE ORGANIZATION WHICH ISSUED THE GROUP CONTRACT. THE ENROLLEE'S  COST
 OF PURCHASING SUCH RIDER SHALL BE THE SAME AS THAT WHICH WOULD HAVE BEEN
 APPLICABLE  HAD THE GROUP CONTRACTHOLDER NOT EXERCISED SUCH ELECTION NOT
 TO PURCHASE COVERAGE.
   (B) WHERE A GROUP CONTRACTHOLDER MAKES AN  ELECTION  NOT  TO  PURCHASE
 COVERAGE FOR CONTRACEPTIVE DRUGS OR DEVICES IN ACCORDANCE WITH PARAGRAPH
 ONE  OF  THIS SUBSECTION, THE INSURER OR HEALTH MAINTENANCE ORGANIZATION
 THAT PROVIDES SUCH COVERAGE SHALL PROVIDE WRITTEN  NOTICE  TO  ENROLLEES
 UPON  ENROLLMENT  WITH THE INSURER OR HEALTH MAINTENANCE ORGANIZATION OF
 THEIR RIGHT TO DIRECTLY PURCHASE A RIDER FOR COVERAGE FOR  THE  COST  OF
 CONTRACEPTIVE  DRUGS OR DEVICES. THE NOTICE SHALL ALSO ADVISE THE ENROL-
 LEES OF THE ADDITIONAL PREMIUM FOR SUCH COVERAGE.
   (3) SUCH COVERAGE MAY BE SUBJECT TO REASONABLE ANNUAL DEDUCTIBLES  AND
 COINSURANCE  AS  MAY  BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS
 ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER DRUGS OR DEVICES COVERED
 UNDER THE POLICY.
   § 8. The second undesignated paragraph of paragraph 26  of  subsection
 (b)  of  section 4322 of the insurance law, as amended by chapter 219 of
 the laws of 2011, is amended to read as follows:
   In determining appropriate coverage provided by subparagraphs (A), (B)
 and (C) of this paragraph, the insurer or health  maintenance  organiza-
 tion  shall  adopt  standards  that  include the criteria of the federal
 Medicare program and the criteria of the national institutes  of  health
 for  the  detection  AND  TREATMENT  of osteoporosis, provided that such
 coverage shall be further determined as follows:
   § 9. Paragraph 16 of subsection (l) of section 3221 of  the  insurance
 law is REPEALED and a new paragraph 16 is added to read as follows:
   (16)  EVERY  GROUP  OR  BLANKET  POLICY  WHICH  PROVIDES  COVERAGE FOR
 PRESCRIPTION DRUGS SHALL INCLUDE COVERAGE FOR THE COST OF  CONTRACEPTIVE
 DRUGS OR DEVICES APPROVED BY THE FEDERAL FOOD AND DRUG ADMINISTRATION OR
 GENERIC EQUIVALENTS APPROVED AS SUBSTITUTES BY SUCH FOOD AND DRUG ADMIN-
 ISTRATION  UNDER  THE  PRESCRIPTION  OF  A  HEALTH CARE PROVIDER LEGALLY
 AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT  OF  THE  EDUCATION  LAW.  THE
 COVERAGE  REQUIRED  BY  THIS  SECTION  SHALL BE INCLUDED IN POLICIES AND
 A. 5939                             4
 
 CERTIFICATES ONLY THROUGH THE ADDITION OF A RIDER. THE PER MEMBER PREMI-
 UM RATE FOR COVERAGE PROVIDED BY THIS RIDER SHALL BE THE  SAME  FOR  ALL
 POLICIES  AND CERTIFICATES OF AN INSURER TO WHICH THE RIDER IS ATTACHED,
 EXCEPT  THAT  AN INSURER MAY RATE THE RIDERS ISSUED WITH ITS SMALL GROUP
 POLICIES SEPARATELY FROM THE RIDERS ISSUED WITH ITS  LARGE  GROUP  POLI-
 CIES.
   (A)  PROVIDED,  HOWEVER,  IF  THE GROUP OR ENTITY, ON WHOSE BEHALF THE
 CONTRACT IS ISSUED IS  OPERATED,  SUPERVISED  OR  CONTROLLED  BY  OR  IN
 CONNECTION  WITH  A  RELIGIOUS  ORGANIZATION  OR DENOMINATIONAL GROUP OR
 ENTITY, THEN NOTHING IN THIS PARAGRAPH SHALL  REQUIRE  THE  CONTRACT  TO
 COVER  ANY CONTRACEPTIVE DRUGS OR DEVICES THAT ARE CONTRARY TO THE RELI-
 GIOUS TENETS OF SUCH GROUP OR ENTITY. IF THE INSURER OR  HEALTH  MAINTE-
 NANCE  ORGANIZATION  DELIVERING THE CONTRACT OR ISSUING THE CONTRACT FOR
 DELIVERY IN THIS STATE IS OPERATED, SPONSORED OR  CONTROLLED  BY  OR  IN
 CONNECTION  WITH  A  RELIGIOUS  ORGANIZATION  OR DENOMINATIONAL GROUP OR
 ENTITY, THEN NOTHING IN THIS PARAGRAPH SHALL  REQUIRE  THE  CONTRACT  TO
 COVER  ANY CONTRACEPTIVE DRUGS OR DEVICES THAT ARE CONTRARY TO THE RELI-
 GIOUS TENETS OF SUCH INSURER OR HEALTH MAINTENANCE ORGANIZATION.
   (B) (I) WHERE A GROUP POLICYHOLDER MAKES AN ELECTION NOT  TO  PURCHASE
 COVERAGE  FOR CONTRACEPTIVE DRUGS OR DEVICES IN ACCORDANCE WITH SUBPARA-
 GRAPH (A) OF THIS PARAGRAPH EACH  CERTIFICATEHOLDER  COVERED  UNDER  THE
 POLICY ISSUED TO THAT GROUP POLICYHOLDER SHALL HAVE THE RIGHT TO DIRECT-
 LY  PURCHASE THE RIDER REQUIRED BY THIS PARAGRAPH FROM THE INSURER WHICH
 ISSUED THE GROUP POLICY. THE CERTIFICATEHOLDER'S COST OF PURCHASING SUCH
 RIDER SHALL BE THE SAME AS THAT WHICH WOULD HAVE BEEN APPLICABLE HAD THE
 GROUP POLICYHOLDER NOT EXERCISED SUCH ELECTION NOT TO PURCHASE COVERAGE.
   (II) WHERE A GROUP POLICYHOLDER MAKES  AN  ELECTION  NOT  TO  PURCHASE
 COVERAGE  FOR CONTRACEPTIVE DRUGS OR DEVICES IN ACCORDANCE WITH SUBPARA-
 GRAPH (A) OF THIS PARAGRAPH, THE INSURER  THAT  PROVIDES  SUCH  COVERAGE
 SHALL  PROVIDE WRITTEN NOTICE TO CERTIFICATEHOLDERS UPON ENROLLMENT WITH
 THE INSURER OF THEIR RIGHT TO DIRECTLY PURCHASE A RIDER FOR COVERAGE FOR
 THE COST OF CONTRACEPTIVE DRUGS OR DEVICES. THE NOTICE SHALL ALSO ADVISE
 THE CERTIFICATEHOLDERS OF THE ADDITIONAL PREMIUM FOR SUCH COVERAGE.
   (C) SUCH COVERAGE MAY BE SUBJECT TO REASONABLE ANNUAL DEDUCTIBLES  AND
 COINSURANCE  AS  MAY  BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS
 ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER DRUGS OR DEVICES COVERED
 UNDER THE POLICY.
   § 10. This act shall take effect on the sixtieth day  after  it  shall
 have become a law and shall apply to all policies issued, renewed, modi-
 fied  or  altered on or after such date; provided, however, that section
 two of this act shall take effect on the  same  date  and  in  the  same
 manner as section 5 of chapter 424 of the laws of 2024, takes effect.