Bill Text: NY A06460 | 2019-2020 | General Assembly | Introduced

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Bill Title: Requires health insurance coverage for craniofacial disorders.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2020-01-08 - referred to insurance [A06460 Detail]

Download: New_York-2019-A06460-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                          6460
                               2019-2020 Regular Sessions
                   IN ASSEMBLY
                                      March 7, 2019
                                       ___________
        Introduced  by  M. of A. FAHY -- read once and referred to the Committee
          on Insurance
        AN ACT to amend the insurance  law,  in  relation  to  health  insurance
          coverage for craniofacial disorders
          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 35 to read as follows:
     3    (35)(A)  Every  policy  delivered or issued for delivery in this state
     4  which provides medical coverage that  includes  coverage  for  physician
     5  services  in  a physician's office and every policy which provides major
     6  medical or similar comprehensive-type coverage  shall  provide  coverage
     7  for  diagnosis and medically necessary treatment, including surgical and
     8  nonsurgical procedures, for a musculoskeletal disorder that affects  any
     9  bone  or  joint in the face, neck or head and is the result of accident,
    10  trauma, congenital defect, developmental defect, or  pathology.  Subject
    11  to  subparagraph  (B) of this paragraph, this coverage shall be the same
    12  as that provided under the health insurance plan for  any  other  muscu-
    13  loskeletal  disorder  in the body and may be provided when prescribed or
    14  administered by a physician or a dentist. This paragraph  shall  not  be
    15  construed  to  require coverage for dental services for the diagnosis or
    16  treatment of dental disorders or dental  pathology  primarily  affecting
    17  the gums, teeth, or alveolar ridge.
    18    (B)  A  referral  from  a health care provider under contract with the
    19  policy may be required.
    20    § 2. Subsection (k) of section 3221 of the insurance law is amended by
    21  adding a new paragraph 22 to read as follows:
    22    (22)(A) Every group or blanket policy delivered or issued for delivery
    23  in this state which provides medical coverage that includes coverage for
    24  physician services in a physician's office or major medical  or  similar
    25  comprehensive-type  coverage  shall  provide  coverage for diagnosis and
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD10293-01-9
        A. 6460                             2
     1  medically necessary treatment, including surgical and nonsurgical proce-
     2  dures, for a musculoskeletal disorder that affects any bone or joint  in
     3  the face, neck or head and is the result of accident, trauma, congenital
     4  defect,  developmental defect, or pathology. Subject to subparagraph (B)
     5  of this paragraph, this coverage shall be  the  same  as  that  provided
     6  under  the  health insurance plan for any other musculoskeletal disorder
     7  in the body and may be provided when prescribed  or  administered  by  a
     8  physician or a dentist. This paragraph shall not be construed to require
     9  coverage  for  dental  services for the diagnosis or treatment of dental
    10  disorders or dental pathology primarily affecting the  gums,  teeth,  or
    11  alveolar ridge.
    12    (B)  A  referral  from  a health care provider under contract with the
    13  policy may be required.
    14    § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
    15  subsection (ss) to read as follows:
    16    (ss)(1)  A  hospital  service  corporation,  medical expense indemnity
    17  corporation or health service corporation which provides medical  cover-
    18  age  that  includes  coverage  for  physician  services in a physician's
    19  office or major medical or  similar  comprehensive-type  coverage  shall
    20  provide  coverage  for  diagnosis  and  medically  necessary  treatment,
    21  including surgical and nonsurgical  procedures,  for  a  musculoskeletal
    22  disorder that affects any bone or joint in the face, neck or head and is
    23  the result of accident, trauma, congenital defect, developmental defect,
    24  or pathology. Subject to paragraph two of this subsection, this coverage
    25  shall  be  the same as that provided under the health insurance plan for
    26  any other musculoskeletal disorder in the body and may be provided  when
    27  prescribed  or administered by a physician or a dentist. This subsection
    28  shall not be construed to require coverage for dental services  for  the
    29  diagnosis or treatment of dental disorders or dental pathology primarily
    30  affecting the gums, teeth, or alveolar ridge.
    31    (2)  A  referral  from  a health care provider under contract with the
    32  policy may be required.
    33    § 4. This act shall take effect on the first of January next  succeed-
    34  ing  the date on which it shall have become a law and shall apply to all
    35  policies issued, renewed, altered or modified on or after such date.