S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5313
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             February 20, 2025
                                ___________
 
 Introduced  by Sens. BAILEY, GALLIVAN, GOUNARDES, HARCKHAM -- read twice
   and ordered printed, and when printed to be committed to the Committee
   on Insurance
 
 AN ACT to amend the insurance law, in relation to addressing non-covered
   dental services
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Section  4224 of the insurance law is amended by adding a
 new subsection (g) to read as follows:
   (G)(1) NOTWITHSTANDING ANY OTHER PROVISION OF THIS SECTION, NO INSURER
 AUTHORIZED TO DO BUSINESS IN THIS STATE SHALL INCLUDE A PROVISION  IN  A
 CONTRACT  OR  PARTICIPATING  PROVIDER  AGREEMENT  WITH  A  DENTIST WHICH
 REQUIRES, DIRECTLY OR INDIRECTLY, THAT A PARTICIPATING  DENTIST  PROVIDE
 SERVICES  TO  AN  INSURED  AT  A  FEE SET BY, OR AT A FEE SUBJECT TO THE
 APPROVAL OF, THE INSURER UNLESS THE DENTAL SERVICES ARE COVERED SERVICES
 UNDER THE INSURED'S DENTAL PLAN.
   (2) FOR PURPOSES OF THIS SUBSECTION,  "COVERED  SERVICES"  SHALL  MEAN
 DENTAL  SERVICES FOR WHICH REIMBURSEMENT IS AVAILABLE UNDER AN INSURED'S
 DENTAL PLAN OR FOR WHICH A REIMBURSEMENT WOULD BE AVAILABLE BUT FOR  THE
 APPLICATION  OF CONTRACTUAL LIMITATIONS SUCH AS DEDUCTIBLES, COPAYMENTS,
 COINSURANCE, WAITING PERIODS, ANNUAL  OR  LIFETIME  MAXIMUMS,  FREQUENCY
 LIMITATIONS, ALTERNATIVE BENEFIT PAYMENTS, OR ANY OTHER LIMITATION.
   §  2. Subsection (s) of section 4303 of the insurance law, as added by
 chapter 293 of the laws of 1992, is amended to read as follows:
   [(s)](S-1)(1) Notwithstanding any provision of a contract issued by  a
 medical expense indemnity corporation, a dental expense indemnity corpo-
 ration  or  health  service  corporation,  every contract which provides
 coverage for care provided through licensed health professionals who can
 bill for services shall provide the same coverage and reimbursement  for
 such  service  provided pursuant to a clinical practice plan established
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07721-01-5
 S. 5313                             2
              

 
 pursuant to subdivision fourteen of  section  two  hundred  six  of  the
 public health law.
   (2)  NOTWITHSTANDING  ANY  OTHER PROVISION OF THIS SECTION, NO MEDICAL
 EXPENSE INDEMNITY CORPORATION, DENTAL EXPENSE INDEMNITY  CORPORATION  OR
 HEALTH SERVICE CORPORATION AUTHORIZED TO DO BUSINESS IN THIS STATE SHALL
 INCLUDE  A  PROVISION  IN A CONTRACT OR PARTICIPATING PROVIDER AGREEMENT
 WITH A DENTIST WHICH REQUIRES, DIRECTLY OR INDIRECTLY,  THAT  A  PARTIC-
 IPATING  DENTIST PROVIDE SERVICES TO AN INSURED AT A FEE SET BY, OR AT A
 FEE SUBJECT TO THE APPROVAL OF, THE MEDICAL EXPENSE    INDEMNITY  CORPO-
 RATION,  DENTAL  EXPENSE  INDEMNITY CORPORATION OR HEALTH SERVICE CORPO-
 RATION UNLESS  THE  DENTAL  SERVICES  ARE  COVERED  SERVICES  UNDER  THE
 INSURED'S DENTAL PLAN.
   (3)  FOR  PURPOSES  OF  THIS SUBSECTION, "COVERED SERVICES" SHALL MEAN
 DENTAL SERVICES FOR WHICH REIMBURSEMENT IS AVAILABLE UNDER AN  INSURED'S
 DENTAL  PLAN OR FOR WHICH A REIMBURSEMENT WOULD BE AVAILABLE BUT FOR THE
 APPLICATION OF CONTRACTUAL LIMITATIONS SUCH AS DEDUCTIBLES,  COPAYMENTS,
 COINSURANCE,  WAITING  PERIODS,  ANNUAL  OR LIFETIME MAXIMUMS, FREQUENCY
 LIMITATIONS, ALTERNATIVE BENEFIT PAYMENTS, OR ANY OTHER LIMITATION.
   § 3. This act shall take effect January 1, 2027 and shall apply to all
 insurance contracts issued or entered into on or after such date.