Bill Text: NY S00760 | 2025-2026 | General Assembly | Introduced

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Bill Title: Clarifies coverage requirements for epinephrine auto-injectors; specifies that such coverage may be subject to the plan's annual deductible.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2025-02-14 - SIGNED CHAP.81 [S00760 Detail]

Download: New_York-2025-S00760-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                           760

                               2025-2026 Regular Sessions

                    IN SENATE

                                       (Prefiled)

                                     January 8, 2025
                                       ___________

        Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
          printed to be committed to the Committee on Rules

        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.  Subparagraph  (A)  of  paragraph  39 of subsection (i) of
     2  section 3216 of the insurance law, as added by a chapter of the laws  of
     3  2024  amending  the insurance law relating to requiring health insurance
     4  plans to provide coverage  for  epinephrine  auto-injector  devices,  as
     5  proposed  in  legislative  bills  numbers  S.  7114-A  and A. 6425-A, is
     6  amended to read as follows:
     7    (A) Every insurer issuing a policy of accident  and  health  insurance
     8  delivered  or  issued  for  delivery  in this state which provides major
     9  medical or similar comprehensive-type coverage and provides coverage for
    10  prescription drugs shall include  coverage  for[,  at  a  minimum,  two]
    11  medically  necessary epinephrine auto-injector devices for the emergency
    12  treatment of life-threatening allergic reactions.  Such coverage may  be
    13  subject  to  annual deductibles and coinsurance  as may be deemed appro-
    14  priate by the superintendent [and as are consistent with those    estab-
    15  lished for other benefits within a given policy]; provided  however, the
    16  total  amount that [a covered person] an insured is required to pay out-
    17  of-pocket for such devices shall be capped at an amount  not  to  exceed
    18  one  hundred  dollars annually regardless   of the insured's deductible,
    19  copayment, coinsurance or any other cost-sharing requirement.  If  under
    20  federal   law,   application  of [this requirement] the annual cap would
    21  result in health savings account ineligibility under 26 USC  223,  [this
    22  requirement  shall  apply  for  health  savings   account-qualified high
    23  deductible health plans with  respect to the deductible of such  a  plan

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02836-01-5
        S. 760                              2

     1  after  the enrollee has satisfied  the  minimum deductible under 26  USC
     2  223] such coverage may be  subject  to  the  plan's  annual  deductible,
     3  except    for   with   respect to items or  services that are preventive
     4  care  pursuant  to 26   USC  223(c)(2)(C),  in  which  case the require-
     5  ments of this paragraph shall apply regardless of   whether the  minimum
     6  deductible under 26 USC 223 has been satisfied.
     7    §  2.  Subparagraph  (A)  of paragraph 23 of subsection (k) of section
     8  3221 of the insurance law, as added by a chapter of  the  laws  of  2024
     9  amending  the insurance law relating to requiring health insurance plans
    10  to provide coverage for epinephrine auto-injector devices,  as  proposed
    11  in legislative bills numbers S. 7114-A and A. 6425-A, is amended to read
    12  as follows:
    13    (A)  Every  group  or  blanket policy of accident and health insurance
    14  delivered or issued for delivery in this state which  provides  [medical
    15  coverage  that includes coverage for physician services in a physician's
    16  office and every policy which provides] major medical or similar compre-
    17  hensive-type coverage and provides coverage for prescription drugs shall
    18  provide coverage for[, at a minimum, two] medically  necessary  epineph-
    19  rine auto-injector devices for the emergency treatment of life-threaten-
    20  ing  allergic reactions.  Such coverage may be subject to annual deduct-
    21  ibles and coinsurance as may be deemed appropriate by the superintendent
    22  [and as are consistent with those  established for other benefits within
    23  a given policy]; provided however, the  total  amount  that  [a  covered
    24  person]  an  insured  is  required to pay out-of-pocket for such devices
    25  shall be capped at an amount not to exceed one hundred dollars  annually
    26  regardless    of the insured's deductible, copayment, coinsurance or any
    27  other cost-sharing requirement.  If under   federal   law,   application
    28  of    [this  requirement]  the annual cap would result in health savings
    29  account ineligibility under 26   USC   223,   [this requirement    shall
    30  apply     for     health     savings account-qualified high   deductible
    31  health  plans  with  respect to the  deductible of such a plan after the
    32  enrollee has satisfied  the  minimum deductible   under 26   USC    223]
    33  such  coverage  may  be subject to the plan's annual deductible,  except
    34  for  with  respect to items or  services that are preventive care pursu-
    35  ant to 26  USC  223(c)(2)(C), in which case  the  requirements  of  this
    36  paragraph  shall  apply  regardless  of   whether the minimum deductible
    37  under 26 USC 223 has been satisfied.
    38    § 3. Paragraph 1 of subsection (vv) of section 4303 of  the  insurance
    39  law,  as  added  by a chapter of the laws of 2024 amending the insurance
    40  law relating to requiring health insurance plans to provide coverage for
    41  epinephrine auto-injector devices,  as  proposed  in  legislative  bills
    42  numbers S. 7114-A and A. 6425-A, is amended to read as follows:
    43    (1)  Every  medical  expense  indemnity  corporation, hospital service
    44  corporation and  health  service  corporation  which  provides  [medical
    45  coverage  that includes coverage for physician services in a physician's
    46  office and every policy which provides] major medical or similar compre-
    47  hensive-type coverage and provides coverage for prescription drugs shall
    48  provide coverage for[, at a minimum, two] medically  necessary  epineph-
    49  rine auto-injector devices for the emergency treatment of life-threaten-
    50  ing  allergic reactions.  Such coverage may be subject to annual deduct-
    51  ibles  and  coinsurance     as  may  be  deemed   appropriate   by   the
    52  superintendent  [and  as are consistent with those established for other
    53  benefits within a given policy]; provided however, the total amount that
    54  [a covered person] an insured is required to pay out-of-pocket for  such
    55  devices  shall  be capped at an amount not to exceed one hundred dollars
    56  annually regardless  of the insured's deductible, copayment, coinsurance
        S. 760                              3

     1  or any other cost-sharing requirement. If under  federal  law,  applica-
     2  tion  of  [this   requirement] the annual cap  would  result  in  health
     3  savings  account  ineligibility  under 26   USC   223, [this requirement
     4  shall    apply    for   health   savings account-qualified high  deduct-
     5  ible  health  plans  with   respect to the deductible  of  such  a  plan
     6  after  the  enrollee has satisfied   the   minimum  deductible  under 26
     7  USC  223] such coverage may be subject to the plan's annual  deductible,
     8  except  for  with  respect to items or services that are preventive care
     9  pursuant  to 26   USC   223(c)(2)(C), in which  case the requirements of
    10  this paragraph shall apply regardless of whether the minimum  deductible
    11  under 26 USC 223 has been satisfied.
    12    §  4.  This  act  shall  take  effect on the same date and in the same
    13  manner as a chapter of the laws  of  2024  amending  the  insurance  law
    14  relating  to  requiring  health  insurance plans to provide coverage for
    15  epinephrine auto-injector devices,  as  proposed  in  legislative  bills
    16  numbers S. 7114-A and A. 6425-A, takes effect.