Bill Text: NY S05313 | 2025-2026 | General Assembly | Introduced

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Bill Title: Addresses non-covered dental services by prohibiting insurers from including in a contract or agreement with a dentist requirements to set fees or require approval fees for services not covered under a person's dental plan; prohibits medical expense indemnity corporations, dental expense indemnity corporations and health service corporations from including in a contract or agreement with a dentist requirements to set fees or require approval fees for services not covered under a person's dental plan.

Spectrum: Slight Partisan Bill (Democrat 3-1)

Status: (Introduced) 2025-02-20 - REFERRED TO INSURANCE [S05313 Detail]

Download: New_York-2025-S05313-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          5313

                               2025-2026 Regular Sessions

                    IN SENATE

                                    February 20, 2025
                                       ___________

        Introduced  by Sens. BAILEY, GALLIVAN, GOUNARDES, HARCKHAM -- read twice
          and ordered printed, and when printed to be committed to the Committee
          on Insurance

        AN ACT to amend the insurance law, in relation to addressing non-covered
          dental services

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1.  Section  4224 of the insurance law is amended by adding a
     2  new subsection (g) to read as follows:
     3    (g)(1) Notwithstanding any other provision of this section, no insurer
     4  authorized to do business in this state shall include a provision  in  a
     5  contract  or  participating  provider  agreement  with  a  dentist which
     6  requires, directly or indirectly, that a participating  dentist  provide
     7  services  to  an  insured  at  a  fee set by, or at a fee subject to the
     8  approval of, the insurer unless the dental services are covered services
     9  under the insured's dental plan.
    10    (2) For purposes of this subsection,  "covered  services"  shall  mean
    11  dental  services for which reimbursement is available under an insured's
    12  dental plan or for which a reimbursement would be available but for  the
    13  application  of contractual limitations such as deductibles, copayments,
    14  coinsurance, waiting periods, annual  or  lifetime  maximums,  frequency
    15  limitations, alternative benefit payments, or any other limitation.
    16    §  2. Subsection (s) of section 4303 of the insurance law, as added by
    17  chapter 293 of the laws of 1992, is amended to read as follows:
    18    [(s)](s-1)(1) Notwithstanding any provision of a contract issued by  a
    19  medical expense indemnity corporation, a dental expense indemnity corpo-
    20  ration  or  health  service  corporation,  every contract which provides
    21  coverage for care provided through licensed health professionals who can
    22  bill for services shall provide the same coverage and reimbursement  for
    23  such  service  provided pursuant to a clinical practice plan established

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD07721-01-5
        S. 5313                             2

     1  pursuant to subdivision fourteen of  section  two  hundred  six  of  the
     2  public health law.
     3    (2)  Notwithstanding  any  other provision of this section, no medical
     4  expense indemnity corporation, dental expense indemnity  corporation  or
     5  health service corporation authorized to do business in this state shall
     6  include  a  provision  in a contract or participating provider agreement
     7  with a dentist which requires, directly or indirectly,  that  a  partic-
     8  ipating  dentist provide services to an insured at a fee set by, or at a
     9  fee subject to the approval of, the medical expense    indemnity  corpo-
    10  ration,  dental  expense  indemnity corporation or health service corpo-
    11  ration unless  the  dental  services  are  covered  services  under  the
    12  insured's dental plan.
    13    (3)  For  purposes  of  this subsection, "covered services" shall mean
    14  dental services for which reimbursement is available under an  insured's
    15  dental  plan or for which a reimbursement would be available but for the
    16  application of contractual limitations such as deductibles,  copayments,
    17  coinsurance,  waiting  periods,  annual  or lifetime maximums, frequency
    18  limitations, alternative benefit payments, or any other limitation.
    19    § 3. This act shall take effect January 1, 2027 and shall apply to all
    20  insurance contracts issued or entered into on or after such date.