Bill Text: NY S07577 | 2023-2024 | General Assembly | Amended

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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) 2024-06-04 - SUBSTITUTED BY A7862A [S07577 Detail]

Download: New_York-2023-S07577-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                         7577--A

                               2023-2024 Regular Sessions

                    IN SENATE

                                      June 8, 2023
                                       ___________

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

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11752-05-4
        S. 7577--A                          2

     1  such service provided pursuant to a clinical practice  plan  established
     2  pursuant  to  subdivision  fourteen  of  section  two hundred six of the
     3  public health law.
     4    (2)  Notwithstanding  any  other provision of this section, no medical
     5  expense indemnity corporation, dental expense indemnity  corporation  or
     6  health service corporation authorized to do business in this state shall
     7  include  a  provision  in a contract or participating provider agreement
     8  with a dentist which requires, directly or indirectly,  that  a  partic-
     9  ipating  dentist provide services to an insured at a fee set by, or at a
    10  fee subject to the approval of, the medical expense    indemnity  corpo-
    11  ration,  dental  expense  indemnity corporation or health service corpo-
    12  ration unless  the  dental  services  are  covered  services  under  the
    13  insured's dental plan.
    14    (3)  For  purposes  of  this subsection, "covered services" shall mean
    15  dental services for which reimbursement is available under an  insured's
    16  dental  plan or for which a reimbursement would be available but for the
    17  application of contractual limitations such as deductibles,  copayments,
    18  coinsurance,  waiting  periods,  annual  or lifetime maximums, frequency
    19  limitations, alternative benefit payments, or any other limitation.
    20    § 3. This act shall take effect January 1, 2025 and shall apply to all
    21  insurance contracts issued or entered into on or after such date.