S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         4776
                              2015-2016 Regular Sessions
                                 I N  A S S E M B L Y
                                   February 6, 2015
                                      ___________
       Introduced  by  M.  of A. CURRAN, FINCH -- read once and referred to the
         Committee on Insurance
       AN ACT to amend the insurance law, in relation to  coverage  of  primary
         and  preventative  obstetric  and  gynecological  care;  and repealing
         certain provisions of such law relating thereto
         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  11 of subsection (l) of
    2  section 3221 of the insurance law, as amended by chapter 219 of the laws
    3  of 2011, is amended to read as follows:
    4    (B) Such coverage required pursuant to subparagraph (A) or (C) of this
    5  paragraph may NOT be subject to annual deductibles and  coinsurance  [as
    6  may  be  deemed  appropriate by the superintendent and as are consistent
    7  with those established for other benefits within a given policy].
    8    S 2. Subparagraph (D) of paragraph 1 of subsection (p) of section 4303
    9  of the insurance law, as amended by chapter 219 of the laws of 2011,  is
   10  amended to read as follows:
   11    (D)  The  coverage required in this paragraph or paragraph two of this
   12  subsection may be subject to annual deductibles and coinsurance [as  may
   13  be  deemed  appropriate by the superintendent and as are consistent with
   14  those established for other benefits within a given contract].
   15    S 3. Subparagraph (C) of paragraph 14 of  subsection  (l)  of  section
   16  3221  of  the  insurance  law,  as amended by chapter 219 of the laws of
   17  2011, is amended to read as follows:
   18    (C) Such coverage required pursuant to subparagraph (A) or (B) of this
   19  paragraph may NOT be subject to annual deductibles and  coinsurance  [as
   20  may  be  deemed  appropriate by the superintendent and as are consistent
   21  with those established for other benefits within a given policy].
   22    S 4. Paragraph 1 of subsection (t) of section 4303  of  the  insurance
   23  law,  as  amended by chapter 219 of the laws of 2011, is amended to read
   24  as follows:
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD08141-01-5
       A. 4776                             2
    1    (1) A medical expense indemnity corporation, a hospital service corpo-
    2  ration or a health service corporation that provides coverage for hospi-
    3  tal, surgical, or medical care shall  provide  coverage  for  an  annual
    4  cervical cytology screening for cervical cancer and its precursor states
    5  for  women aged eighteen and older. Such coverage required by this para-
    6  graph may NOT be subject to annual deductibles and coinsurance  [as  may
    7  be  deemed  appropriate by the superintendent and as are consistent with
    8  those established for other benefits within a given contract].
    9    S 5. The opening paragraph  of  paragraph  13  of  subsection  (k)  of
   10  section 3221 of the insurance law, as amended by chapter 219 of the laws
   11  of 2011, is amended to read as follows:
   12    Every group or blanket policy delivered or issued for delivery in this
   13  state that provides major medical or similar comprehensive-type coverage
   14  shall  provide  such  coverage  for bone mineral density measurements or
   15  tests, and if such contract otherwise includes coverage for prescription
   16  drugs, drugs and devices approved by the federal food and drug  adminis-
   17  tration  or generic equivalents as approved substitutes.  In determining
   18  appropriate coverage provided by subparagraphs (A), (B) and (C) of  this
   19  paragraph,  the  insurer  or health maintenance organization shall adopt
   20  standards that include the criteria of the federal Medicare program  and
   21  the  criteria of the national institutes of health for the detection AND
   22  TREATMENT of osteoporosis, provided that such coverage shall be  further
   23  determined as follows:
   24    S  6.  The opening paragraph of subsection (bb) of section 4303 of the
   25  insurance law, as amended by chapter 219 of the laws of 2011, is amended
   26  to read as follows:
   27    A health service corporation or a medical  service  expense  indemnity
   28  corporation  that  provides  major medical or similar comprehensive-type
   29  coverage shall provide such coverage for bone mineral  density  measure-
   30  ments  or  tests,  and  if such contract otherwise includes coverage for
   31  prescription drugs, drugs and devices approved by the federal  food  and
   32  drug  administration  or generic equivalents as approved substitutes. In
   33  determining appropriate coverage provided by  paragraphs  one,  two  and
   34  three of this subsection, the insurer or health maintenance organization
   35  shall  adopt standards that include the criteria of the federal Medicare
   36  program and the criteria of the national institutes of  health  for  the
   37  detection  AND  TREATMENT  of  osteoporosis, provided that such coverage
   38  shall be further determined as follows:
   39    S 7. Subsection (cc) of section 4303 of the insurance law is  REPEALED
   40  and a new subsection (cc) is added to read as follows:
   41    (CC)  EVERY  CONTRACT  WHICH  PROVIDES COVERAGE FOR PRESCRIPTION DRUGS
   42  SHALL INCLUDE COVERAGE FOR THE COST OF CONTRACEPTIVE  DRUGS  OR  DEVICES
   43  APPROVED  BY  THE FEDERAL FOOD AND DRUG ADMINISTRATION OR GENERIC EQUIV-
   44  ALENTS APPROVED AS SUBSTITUTES BY  SUCH  FOOD  AND  DRUG  ADMINISTRATION
   45  UNDER  THE  PRESCRIPTION OF A HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO
   46  PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW. THE COVERAGE  REQUIRED
   47  BY  THIS  SECTION  SHALL  BE INCLUDED IN CONTRACTS AND CERTIFICATES ONLY
   48  THROUGH THE ADDITION OF A RIDER. THE PER MEMBER PREMIUM RATE FOR  COVER-
   49  AGE  PROVIDED  BY  THIS  RIDER  SHALL  BE THE SAME FOR ALL CONTRACTS AND
   50  CERTIFICATES OF AN INSURER OR HEALTH MAINTENANCE ORGANIZATION  TO  WHICH
   51  THE  RIDER  IS  ATTACHED,  EXCEPT  THAT AN INSURER OR HEALTH MAINTENANCE
   52  ORGANIZATION MAY RATE THE RIDERS ISSUED WITH ITS  SMALL  GROUP  POLICIES
   53  SEPARATELY FROM THE RIDERS ISSUED WITH ITS LARGE GROUP CONTRACTS.
   54    (1)  PROVIDED,  HOWEVER,  IF  THE GROUP OR ENTITY, ON WHOSE BEHALF THE
   55  CONTRACT IS ISSUED IS  OPERATED,  SUPERVISED  OR  CONTROLLED  BY  OR  IN
   56  CONNECTION  WITH  A  RELIGIOUS  ORGANIZATION  OR DENOMINATIONAL GROUP OR
       A. 4776                             3
    1  ENTITY, THEN NOTHING IN THIS SUBSECTION SHALL REQUIRE  THE  CONTRACT  TO
    2  COVER  ANY CONTRACEPTIVE DRUGS OR DEVICES THAT ARE CONTRARY TO THE RELI-
    3  GIOUS TENETS OF SUCH GROUP OR ENTITY. IF THE INSURER OR  HEALTH  MAINTE-
    4  NANCE  ORGANIZATION  DELIVERING THE CONTRACT OR ISSUING THE CONTRACT FOR
    5  DELIVERY IN THIS STATE IS OPERATED, SPONSORED OR  CONTROLLED  BY  OR  IN
    6  CONNECTION  WITH  A  RELIGIOUS  ORGANIZATION  OR DENOMINATIONAL GROUP OR
    7  ENTITY, THEN NOTHING IN THIS SUBSECTION SHALL REQUIRE  THE  CONTRACT  TO
    8  COVER  ANY CONTRACEPTIVE DRUGS OR DEVICES THAT ARE CONTRARY TO THE RELI-
    9  GIOUS TENETS OF SUCH INSURER OR HEALTH MAINTENANCE ORGANIZATION.
   10    (2)(A) WHERE A GROUP CONTRACTHOLDER MAKES AN ELECTION NOT TO  PURCHASE
   11  COVERAGE FOR CONTRACEPTIVE DRUGS OR DEVICES IN ACCORDANCE WITH PARAGRAPH
   12  ONE  OF THIS SUBSECTION, EACH ENROLLEE COVERED UNDER THE CONTRACT ISSUED
   13  TO THAT GROUP CONTRACTHOLDER SHALL HAVE THE RIGHT TO  DIRECTLY  PURCHASE
   14  THE RIDER REQUIRED BY THIS SUBSECTION FROM THE INSURER OR HEALTH MAINTE-
   15  NANCE  ORGANIZATION WHICH ISSUED THE GROUP CONTRACT. THE ENROLLEE'S COST
   16  OF PURCHASING SUCH RIDER SHALL BE THE SAME AS THAT WHICH WOULD HAVE BEEN
   17  APPLICABLE HAD THE GROUP CONTRACTHOLDER NOT EXERCISED SUCH ELECTION  NOT
   18  TO PURCHASE COVERAGE.
   19    (B)  WHERE  A  GROUP  CONTRACTHOLDER MAKES AN ELECTION NOT TO PURCHASE
   20  COVERAGE FOR CONTRACEPTIVE DRUGS OR DEVICES IN ACCORDANCE WITH PARAGRAPH
   21  ONE OF THIS SUBSECTION, THE INSURER OR HEALTH  MAINTENANCE  ORGANIZATION
   22  THAT  PROVIDES  SUCH  COVERAGE SHALL PROVIDE WRITTEN NOTICE TO ENROLLEES
   23  UPON ENROLLMENT WITH THE INSURER OR HEALTH MAINTENANCE  ORGANIZATION  OF
   24  THEIR  RIGHT  TO  DIRECTLY PURCHASE A RIDER FOR COVERAGE FOR THE COST OF
   25  CONTRACEPTIVE DRUGS OR DEVICES. THE NOTICE SHALL ALSO ADVISE THE  ENROL-
   26  LEES OF THE ADDITIONAL PREMIUM FOR SUCH COVERAGE.
   27    (3)  SUCH COVERAGE MAY BE SUBJECT TO REASONABLE ANNUAL DEDUCTIBLES AND
   28  COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE  SUPERINTENDENT  AND  AS
   29  ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER DRUGS OR DEVICES COVERED
   30  UNDER THE POLICY.
   31    S  8.  The second undesignated paragraph of paragraph 26 of subsection
   32  (b) of section 4322 of the insurance law, as amended by chapter  219  of
   33  the laws of 2011, is amended to read as follows:
   34    In determining appropriate coverage provided by subparagraphs (A), (B)
   35  and  (C)  of this paragraph, the insurer or health maintenance organiza-
   36  tion shall adopt standards that include  the  criteria  of  the  federal
   37  Medicare  program  and the criteria of the national institutes of health
   38  for the detection AND TREATMENT  of  osteoporosis,  provided  that  such
   39  coverage shall be further determined as follows:
   40    S  9.  Paragraph 16 of subsection (l) of section 3221 of the insurance
   41  law is REPEALED and a new paragraph 16 is added to read as follows:
   42    (16) EVERY  GROUP  OR  BLANKET  POLICY  WHICH  PROVIDES  COVERAGE  FOR
   43  PRESCRIPTION  DRUGS SHALL INCLUDE COVERAGE FOR THE COST OF CONTRACEPTIVE
   44  DRUGS OR DEVICES APPROVED BY THE FEDERAL FOOD AND DRUG ADMINISTRATION OR
   45  GENERIC EQUIVALENTS APPROVED AS SUBSTITUTES BY SUCH FOOD AND DRUG ADMIN-
   46  ISTRATION UNDER THE PRESCRIPTION  OF  A  HEALTH  CARE  PROVIDER  LEGALLY
   47  AUTHORIZED  TO  PRESCRIBE  UNDER  TITLE  EIGHT OF THE EDUCATION LAW. THE
   48  COVERAGE REQUIRED BY THIS SECTION SHALL  BE  INCLUDED  IN  POLICIES  AND
   49  CERTIFICATES ONLY THROUGH THE ADDITION OF A RIDER. THE PER MEMBER PREMI-
   50  UM  RATE  FOR  COVERAGE PROVIDED BY THIS RIDER SHALL BE THE SAME FOR ALL
   51  POLICIES AND CERTIFICATES OF AN INSURER TO WHICH THE RIDER IS  ATTACHED,
   52  EXCEPT  THAT  AN INSURER MAY RATE THE RIDERS ISSUED WITH ITS SMALL GROUP
   53  POLICIES SEPARATELY FROM THE RIDERS ISSUED WITH ITS  LARGE  GROUP  POLI-
   54  CIES.
   55    (A)  PROVIDED,  HOWEVER,  IF  THE GROUP OR ENTITY, ON WHOSE BEHALF THE
   56  CONTRACT IS ISSUED IS  OPERATED,  SUPERVISED  OR  CONTROLLED  BY  OR  IN
       A. 4776                             4
    1  CONNECTION  WITH  A  RELIGIOUS  ORGANIZATION  OR DENOMINATIONAL GROUP OR
    2  ENTITY, THEN NOTHING IN THIS PARAGRAPH SHALL  REQUIRE  THE  CONTRACT  TO
    3  COVER  ANY CONTRACEPTIVE DRUGS OR DEVICES THAT ARE CONTRARY TO THE RELI-
    4  GIOUS  TENETS  OF SUCH GROUP OR ENTITY. IF THE INSURER OR HEALTH MAINTE-
    5  NANCE ORGANIZATION DELIVERING THE CONTRACT OR ISSUING THE  CONTRACT  FOR
    6  DELIVERY  IN  THIS  STATE  IS OPERATED, SPONSORED OR CONTROLLED BY OR IN
    7  CONNECTION WITH A RELIGIOUS  ORGANIZATION  OR  DENOMINATIONAL  GROUP  OR
    8  ENTITY,  THEN  NOTHING  IN  THIS PARAGRAPH SHALL REQUIRE THE CONTRACT TO
    9  COVER ANY CONTRACEPTIVE DRUGS OR DEVICES THAT ARE CONTRARY TO THE  RELI-
   10  GIOUS TENETS OF SUCH INSURER OR HEALTH MAINTENANCE ORGANIZATION.
   11    (B)  (I)  WHERE A GROUP POLICYHOLDER MAKES AN ELECTION NOT TO PURCHASE
   12  COVERAGE FOR CONTRACEPTIVE DRUGS OR DEVICES IN ACCORDANCE WITH  SUBPARA-
   13  GRAPH  (A)  OF  THIS  PARAGRAPH EACH CERTIFICATEHOLDER COVERED UNDER THE
   14  POLICY ISSUED TO THAT GROUP POLICYHOLDER SHALL HAVE THE RIGHT TO DIRECT-
   15  LY PURCHASE THE RIDER REQUIRED BY THIS PARAGRAPH FROM THE INSURER  WHICH
   16  ISSUED THE GROUP POLICY. THE CERTIFICATEHOLDER'S COST OF PURCHASING SUCH
   17  RIDER SHALL BE THE SAME AS THAT WHICH WOULD HAVE BEEN APPLICABLE HAD THE
   18  GROUP POLICYHOLDER NOT EXERCISED SUCH ELECTION NOT TO PURCHASE COVERAGE.
   19    (II)  WHERE  A  GROUP  POLICYHOLDER  MAKES AN ELECTION NOT TO PURCHASE
   20  COVERAGE FOR CONTRACEPTIVE DRUGS OR DEVICES IN ACCORDANCE WITH  SUBPARA-
   21  GRAPH  (A)  OF  THIS  PARAGRAPH, THE INSURER THAT PROVIDES SUCH COVERAGE
   22  SHALL PROVIDE WRITTEN NOTICE TO CERTIFICATEHOLDERS UPON ENROLLMENT  WITH
   23  THE INSURER OF THEIR RIGHT TO DIRECTLY PURCHASE A RIDER FOR COVERAGE FOR
   24  THE COST OF CONTRACEPTIVE DRUGS OR DEVICES. THE NOTICE SHALL ALSO ADVISE
   25  THE CERTIFICATEHOLDERS OF THE ADDITIONAL PREMIUM FOR SUCH COVERAGE.
   26    (C)  SUCH COVERAGE MAY BE SUBJECT TO REASONABLE ANNUAL DEDUCTIBLES AND
   27  COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE  SUPERINTENDENT  AND  AS
   28  ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER DRUGS OR DEVICES COVERED
   29  UNDER THE POLICY.
   30    S  10.  This  act shall take effect on the sixtieth day after it shall
   31  have become a law and shall apply to all policies issued, renewed, modi-
   32  fied or altered on or after such date.