Bill Text: NY A06496 | 2013-2014 | General Assembly | Introduced

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Bill Title: Requires insurance coverage under health insurance plans for diagnosis and treatment of craniofacial disorder; provides a referral from a health care provider under contract with the policy may be required.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2014-01-08 - referred to insurance [A06496 Detail]

Download: New_York-2013-A06496-Introduced.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         6496
                              2013-2014 Regular Sessions
                                 I N  A S S E M B L Y
                                     April 4, 2013
                                      ___________
       Introduced by M. of A. JACOBS -- 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 30 to read as follows:
    3    (30)(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    S 2. Subsection (k) of section 3221 of the insurance law is amended by
   21  adding a new paragraph 19 to read as follows:
   22    (19)(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.
                                                                  LBD02286-01-3
       A. 6496                             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    S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
   15  subsection (jj) to read as follows:
   16    (JJ)(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    S 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.