Bill Text: NY A08001 | 2023-2024 | General Assembly | Introduced

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Bill Title: Requires health insurance plans to provide coverage for medically necessary epinephrine auto-injector devices; caps the out-of-pocket cost of the co-pay or deductible for such epi-pens at sixty dollars.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-01-03 - referred to insurance [A08001 Detail]

Download: New_York-2023-A08001-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          8001

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                    September 1, 2023
                                       ___________

        Introduced  by  M.  of  A. L. ROSENTHAL -- read once and referred to the
          Committee on Insurance

        AN ACT to amend the insurance  law,  in  relation  to  requiring  health
          insurance  plans  to  provide  coverage  for epinephrine auto-injector
          devices and capping the co-pay  or  deductible  for  such  epinephrine
          auto-injector devices at sixty dollars

          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 39 to read as follows:
     3    (39)  (A) Every insurer issuing a policy of accident and health insur-
     4  ance delivered or issued for  delivery  in  this  state  which  provides
     5  medical  coverage  that  includes  coverage  for physician services in a
     6  physician's office and every policy  which  provides  major  medical  or
     7  similar comprehensive-type coverage shall include coverage for medically
     8  necessary  epinephrine auto-injector devices for the emergency treatment
     9  of life-threatening allergic reactions.
    10    (B) Such coverage may be subject to annual deductibles and coinsurance
    11  as may be deemed appropriate by the superintendent and as are consistent
    12  with those  established  for  other  benefits  within  a  given  policy;
    13  provided  however, the total amount that a covered person is required to
    14  pay out-of-pocket for two epinephrine  auto-injector  devices  shall  be
    15  capped  at  an amount not to exceed sixty dollars per thirty-day supply,
    16  regardless of the insured's deductible, copayment,  coinsurance  or  any
    17  other cost sharing requirement.
    18    (C)  Nothing  in this section shall prevent an insurer from reducing a
    19  covered person's cost sharing to an amount that is lower than the amount
    20  specified in subparagraph (B) of this paragraph.
    21    (D) For the purposes of  this  paragraph,  "epinephrine  auto-injector
    22  device"  shall  have  the  same  meaning as provided in paragraph (b) of
    23  subdivision one of section three thousand-c of the public health law.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD13118-01-3
        A. 8001                             2

     1    § 2. Subsection (k) of section 3221 of the insurance law is amended by
     2  adding a new paragraph 23 to read as follows:
     3    (23)  (A)  Every group or blanket accident and health insurance policy
     4  issued or issued for delivery  in  this  state  which  provides  medical
     5  coverage  that includes coverage for physician services in a physician's
     6  office and every policy which provides major medical or similar  compre-
     7  hensive-type  coverage  shall  include  coverage for medically necessary
     8  epinephrine auto-injector devices for the emergency treatment  of  life-
     9  threatening allergic reactions.
    10    (B) Such coverage may be subject to annual deductibles and coinsurance
    11  as may be deemed appropriate by the superintendent and as are consistent
    12  with  those  established  for  other  benefits  within  a  given policy;
    13  provided however, the total amount that a covered person is required  to
    14  pay  out-of-pocket  for  two  epinephrine auto-injector devices shall be
    15  capped at an amount not to exceed sixty dollars per  thirty-day  supply,
    16  regardless  of  the  insured's deductible, copayment, coinsurance or any
    17  other cost sharing requirement.
    18    (C) Nothing in this section shall prevent an insurer from  reducing  a
    19  covered person's cost sharing to an amount that is lower than the amount
    20  specified in subparagraph (B) of this paragraph.
    21    (D)  For  the  purposes  of this paragraph, "epinephrine auto-injector
    22  device" shall have the same meaning as  provided  in  paragraph  (b)  of
    23  subdivision one of section three thousand-c of the public health law.
    24    §  3.  Section  4303  of  the insurance law is amended by adding a new
    25  subsection (vv) to read as follows:
    26    (vv) (1) Every medical expense indemnity corporation, hospital service
    27  corporation and health service corporation which provides medical cover-
    28  age that includes coverage  for  physician  services  in  a  physician's
    29  office  and every policy which provides major medical or similar compre-
    30  hensive-type coverage shall include  coverage  for  medically  necessary
    31  epinephrine  auto-injector  devices for the emergency treatment of life-
    32  threatening allergic reactions.
    33    (2) Such coverage may be subject to annual deductibles and coinsurance
    34  as may be deemed appropriate by the superintendent and as are consistent
    35  with those  established  for  other  benefits  within  a  given  policy;
    36  provided  however, the total amount that a covered person is required to
    37  pay out-of-pocket for two epinephrine  auto-injector  devices  shall  be
    38  capped  at  an amount not to exceed sixty dollars per thirty-day supply,
    39  regardless of the insured's deductible, copayment,  coinsurance  or  any
    40  other cost sharing requirement.
    41    (3)  Nothing  in this section shall prevent an insurer from reducing a
    42  covered person's cost sharing to an amount that is lower than the amount
    43  specified in paragraph two of this subsection.
    44    (4) For the purposes of this  subsection,  "epinephrine  auto-injector
    45  device"  shall  have  the  same  meaning as provided in paragraph (b) of
    46  subdivision one of section three thousand-c of the public health law.
    47    § 4. This act shall take effect on the first of January next  succeed-
    48  ing  the date on which it shall have become a law and shall apply to all
    49  policies and contracts issued, renewed, modified, altered, or amended on
    50  or after such  date.  Effective  immediately,  the  addition,  amendment
    51  and/or repeal of any rule or regulation necessary for the implementation
    52  of  this  act  on  its  effective  date  are  authorized  to be made and
    53  completed on or before such effective date.