Bill Text: NY A06425 | 2023-2024 | General Assembly | Amended
Bill Title: Requires health insurance plans to provide coverage for epinephrine auto-injector devices; caps the cost to an insured at $100 per year.
Spectrum: Moderate Partisan Bill (Democrat 25-7)
Status: (Introduced - Dead) 2024-05-30 - substituted by s7114a [A06425 Detail]
Download: New_York-2023-A06425-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 6425--A 2023-2024 Regular Sessions IN ASSEMBLY 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: 1 Section 1. Subsection (i) of section 3216 of the insurance law is 2 amended by adding a new paragraph 39 to read as follows: 3 (39) (A) Every insurer issuing a policy of accident and health insur- 4 ance delivered or issued for delivery in this state which provides major 5 medical or similar comprehensive-type coverage shall include coverage 6 for, at a minimum, two medically necessary epinephrine auto-injector 7 devices for the emergency treatment of life-threatening allergic 8 reactions. Such coverage may be subject to annual deductibles and coin- 9 surance as may be deemed appropriate by the superintendent and as are 10 consistent with those established for other benefits within a given 11 policy; provided however, the total amount that a covered person is 12 required to pay out-of-pocket for such devices shall be capped at an 13 amount not to exceed one hundred dollars annually regardless of the 14 insured's deductible, copayment, coinsurance or any other cost-sharing 15 requirement. If under federal law, application of this requirement 16 would result in health savings account ineligibility under 26 USC 17 223, this requirement shall apply for health savings 18 account-qualified high deductible health plans with respect to the 19 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. LBD10597-02-4A. 6425--A 2 1 deductible under 26 USC 223, except for with respect to items or 2 services that are preventive care pursuant to 26 USC 223(c)(2)(C), in 3 which case the requirements of this paragraph shall apply regardless of 4 whether the minimum deductible under 26 USC 223 has been satisfied. 5 (B) For the purposes of this paragraph, "epinephrine auto-injector 6 device" shall have the same meaning as provided in paragraph (b) of 7 subdivision one of section three thousand-c of the public health law. 8 § 2. Subsection (k) of section 3221 of the insurance law is amended by 9 adding a new paragraph 23 to read as follows: 10 (23) (A) Every group or blanket policy of accident and health insur- 11 ance delivered or issued for delivery in this state which provides 12 medical coverage that includes coverage for physician services in a 13 physician's office and every policy which provides major medical or 14 similar comprehensive-type coverage shall provide coverage for, at a 15 minimum, two medically necessary epinephrine auto-injector devices for 16 the emergency treatment of life-threatening allergic reactions. Such 17 coverage may be subject to annual deductibles and coinsurance as may be 18 deemed appropriate by the superintendent and as are consistent with 19 those established for other benefits within a given policy; provided 20 however, the total amount that a covered person is required to pay out- 21 of-pocket for such devices shall be capped at an amount not to exceed 22 one hundred dollars annually regardless of the insured's deductible, 23 copayment, coinsurance or any other cost-sharing requirement. If under 24 federal law, application of this requirement would result in health 25 savings account ineligibility under 26 USC 223, this requirement 26 shall apply for health savings account-qualified high deduct- 27 ible health plans with respect to the deductible of such a plan 28 after the enrollee has satisfied the minimum deductible under 26 USC 29 223, except for with respect to items or services that are preven- 30 tive care pursuant to 26 USC 223(c)(2)(C), in which case the 31 requirements of this paragraph shall apply regardless of whether the 32 minimum deductible under 26 USC 223 has been satisfied. 33 (B) For the purposes of this paragraph, "epinephrine auto-injector 34 device" shall have the same meaning as provided in paragraph (b) of 35 subdivision one of section three thousand-c of the public health law. 36 § 3. Section 4303 of the insurance law is amended by adding a new 37 subsection (vv) to read as follows: 38 (vv) (1) Every medical expense indemnity corporation, hospital service 39 corporation and health service corporation which provides medical cover- 40 age that includes coverage for physician services in a physician's 41 office and every policy which provides major medical or similar compre- 42 hensive-type coverage shall provide coverage for, at a minimum, two 43 medically necessary epinephrine auto-injector devices for the emergency 44 treatment of life-threatening allergic reactions. Such coverage may be 45 subject to annual deductibles and coinsurance as may be deemed appro- 46 priate by the superintendent and as are consistent with those estab- 47 lished for other benefits within a given policy; provided however, the 48 total amount that a covered person is required to pay out-of-pocket for 49 such devices shall be capped at an amount not to exceed one hundred 50 dollars annually regardless of the insured's deductible, copayment, 51 coinsurance or any other cost-sharing requirement. If under federal 52 law, application of this requirement would result in health savings 53 account ineligibility under 26 USC 223, this requirement shall 54 apply for health savings account-qualified high deductible 55 health plans with respect to the deductible of such a plan after the 56 enrollee has satisfied the minimum deductible under 26 USC 223,A. 6425--A 3 1 except for with respect to items or services that are preventive care 2 pursuant to 26 USC 223(c)(2)(C), in which case the requirements of 3 this paragraph shall apply regardless of whether the minimum deductible 4 under 26 USC 223 has been satisfied. 5 (2) For the purposes of this subsection, "epinephrine auto-injector 6 device" shall have the same meaning as provided in paragraph (b) of 7 subdivision one of section three thousand-c of the public health law. 8 § 4. This act shall take effect January 1, 2026 and shall apply to all 9 policies and contracts issued, renewed, modified, altered or amended on 10 or after such date.
