Bill Text: NY S06045 | 2017-2018 | General Assembly | Amended
Bill Title: Relates to coverage for eating disorders; requires comparable coverage for adults and children with eating disorders; defines eating disorder.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2018-04-13 - PRINT NUMBER 6045C [S06045 Detail]
Download: New_York-2017-S06045-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 6045--C 2017-2018 Regular Sessions IN SENATE May 10, 2017 ___________ Introduced by Sens. MARCHIONE, ALCANTARA, BRESLIN, CARLUCCI, FUNKE, HOYLMAN, KAMINSKY, LANZA, RANZENHOFER -- read twice and ordered print- ed, and when printed to be committed to the Committee on Insurance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- recommitted to the Committee on Insurance in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law, in relation to coverage for eating disorders The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subparagraph (B) of paragraph 5 of subsection (1) of 2 section 3221 of the insurance law, as amended by chapter 502 of the laws 3 of 2007, is amended to read as follows: 4 (B) (i) Every insurer delivering a group or school blanket policy or 5 issuing a group or school blanket policy for delivery, in this state, 6 which provides coverage for inpatient hospital care or coverage for 7 physician services, shall provide comparable coverage for adults and 8 children with biologically based mental illness. Such group policies 9 issued or delivered in this state shall also provide such comparable 10 coverage for children with serious emotional disturbances. Such coverage 11 shall be provided under the terms and conditions otherwise applicable 12 under the policy, including network limitations or variations, exclu- 13 sions, co-pays, coinsurance, deductibles or other specific cost sharing 14 mechanisms. Provided further, where a policy provides both in-network 15 and out-of-network benefits, the out-of-network benefits may have 16 different coinsurance, co-pays, or deductibles, than the in-network 17 benefits, regardless of whether the policy is written under one license 18 or two licenses. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD06526-07-8S. 6045--C 2 1 (ii) For purposes of this paragraph, the term "biologically based 2 mental illness" means a mental, nervous, or emotional condition that is 3 caused by a biological disorder of the brain and results in a clinically 4 significant, psychological syndrome or pattern that substantially limits 5 the functioning of the person with the illness. Such biologically based 6 mental illnesses are defined as schizophrenia/psychotic disorders, major 7 depression, bipolar disorder, delusional disorders, panic disorder, 8 obsessive compulsive disorders[, bulimia, and anorexia] or an eating 9 disorder. 10 (iii) For purposes of this paragraph, the term "eating disorder" means 11 pica, rumination disorder, avoidant/restrictive food intake disorder, 12 anorexia nervosa, bulimia nervosa, binge eating disorder, other speci- 13 fied feeding or eating disorder, and any other eating disorder contained 14 in the most recent version of the Diagnostic and Statistical Manual of 15 Mental Disorders published by the American Psychiatric Association. 16 § 2. Paragraph 2 of subsection (g) of section 4303 of the insurance 17 law, as amended by chapter 502 of the laws of 2007, is amended to read 18 as follows: 19 (2) (A) A hospital service corporation or a health service corpo- 20 ration, which provides group, group remittance or school blanket cover- 21 age for inpatient hospital care, shall provide comparable coverage for 22 adults and children with biologically based mental illness. Such hospi- 23 tal service corporation or health service corporation shall also provide 24 such comparable coverage for children with serious emotional disturb- 25 ances. Such coverage shall be provided under the terms and conditions 26 otherwise applicable under the contract, including network limitations 27 or variations, exclusions, co-pays, coinsurance, deductibles or other 28 specific cost sharing mechanisms. Provided further, where a contract 29 provides both in-network and out-of-network benefits, the out-of-network 30 benefits may have different coinsurance, co-pays, or deductibles, than 31 the in-network benefits, regardless of whether the contract is written 32 under one license or two licenses. 33 (B) For purposes of this subsection, the term "biologically based 34 mental illness" means a mental, nervous, or emotional condition that is 35 caused by a biological disorder of the brain and results in a clinically 36 significant, psychological syndrome or pattern that substantially limits 37 the functioning of the person with the illness. Such biologically based 38 mental illnesses are defined as schizophrenia/psychotic disorders, major 39 depression, bipolar disorder, delusional disorders, panic disorder, 40 obsessive compulsive disorders[, anorexia, and bulimia] or an eating 41 disorder. 42 (C) For purposes of this subsection, the term "eating disorder" means 43 pica, rumination disorder, avoidant/restrictive food intake disorder, 44 anorexia nervosa, bulimia nervosa, binge eating disorder, other speci- 45 fied feeding or eating disorder, and any other eating disorder contained 46 in the most recent version of the Diagnostic and Statistical Manual of 47 Mental Disorders published by the American Psychiatric Association. 48 § 3. Paragraph 2 of subsection (h) of section 4303 of the insurance 49 law, as amended by chapter 502 of the laws of 2007, is amended to read 50 as follows: 51 (2) (A) A medical expense indemnity corporation or a health service 52 corporation, which provides group, group remittance or school blanket 53 coverage for physician services, shall provide comparable coverage for 54 adults and children with biologically based mental illness. Such medical 55 expense indemnity corporation or health service corporation shall also 56 provide such comparable coverage for children with serious emotionalS. 6045--C 3 1 disturbances. Such coverage shall be provided under the terms and condi- 2 tions otherwise applicable under the contract, including network limita- 3 tions or variations, exclusions, co-pays, coinsurance, deductibles or 4 other specific cost sharing mechanisms. Provided further, where a 5 contract provides both in-network and out-of-network benefits, the out- 6 of-network benefits may have different coinsurance, co-pays, or deduct- 7 ibles, than the in-network benefits, regardless of whether the contract 8 is written under one license or two licenses. 9 (B) For purposes of this subsection, the term "biologically based 10 mental illness" means a mental, nervous, or emotional condition that is 11 caused by a biological disorder of the brain and results in a clinically 12 significant, psychological syndrome or pattern that substantially limits 13 the functioning of the person with the illness. Such biologically based 14 mental illnesses are defined as schizophrenia/psychotic disorders, major 15 depression, bipolar disorder, delusional disorders, panic disorder, 16 obsessive compulsive disorder[, anorexia, and bulimia] or an eating 17 disorder. 18 (C) For purposes of this subsection, the term "eating disorder" means 19 pica, rumination disorder, avoidant/restrictive food intake disorder, 20 anorexia nervosa, bulimia nervosa, binge eating disorder, other speci- 21 fied feeding or eating disorder, and any other eating disorder contained 22 in the most recent version of the Diagnostic and Statistical Manual of 23 Mental Disorders published by the American Psychiatric Association. 24 § 4. This act shall take effect on the ninetieth day after it shall 25 have become a law; provided, however, that the provisions of this act 26 shall apply to policies and contracts issued, renewed, modified, altered 27 or amended on or after such effective date.
