Bill Text: NY S10607 | 2025-2026 | General Assembly | Introduced
Bill Title: Mandates insurance policies which cover restorative dental services to provide coverage for endodontic services including exams, imaging, root canals and post-treatment care.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced - Dead) 2026-05-29 - REFERRED TO INSURANCE [S10607 Detail]
Download: New_York-2025-S10607-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 10607 IN SENATE May 29, 2026 ___________ Introduced by Sen. ADDABBO -- 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 insurance coverage for endodontic services 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 42 to read as follows: 3 (42) (A) Every policy which provides coverage or reimbursement for 4 dental services which includes coverage for restorative dental services 5 shall provide coverage for medically necessary endodontic services 6 performed by a licensed dentist acting within the lawful scope of prac- 7 tice, including a licensed endodontist. 8 (B) Such coverage shall include, but not be limited to: 9 (i) diagnostic examinations and evaluations; 10 (ii) specialist consultations; 11 (iii) radiographic and diagnostic imaging; 12 (iv) root canal therapy; 13 (v) endodontic retreatment procedures; 14 (vi) apicoectomy procedures; 15 (vii) emergency endodontic treatment; and 16 (viii) post-treatment care reasonably related to endodontic treatment. 17 (C) An insurer shall not deny coverage for a medically necessary 18 covered service solely because such service is rendered by a licensed 19 endodontist rather than a general dentist. 20 (D) If an insurer does not maintain an adequate network of participat- 21 ing endodontists to ensure reasonable access to covered endodontic 22 services without unreasonable delay, the insurer shall provide coverage 23 for services rendered by a non-participating endodontist at no greater 24 cost-sharing obligation than would apply to services rendered by a 25 participating provider. 26 (E) No policy subject to this paragraph shall impose annual limita- 27 tions, frequency limitations, or utilization review requirements for 28 medically necessary endodontic services that are more restrictive than EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD15989-01-6S. 10607 2 1 those applied to other comparable restorative dental services covered 2 under the policy. 3 (F) For purposes of this paragraph, "medically necessary endodontic 4 services" means dental services necessary to diagnose, treat, relieve, 5 or prevent infection, pain, disease, or damage affecting the dental pulp 6 or surrounding tissues, consistent with generally accepted standards of 7 dental practice. 8 § 2. Subsection (l) of section 3221 of the insurance law is amended by 9 adding a new paragraph 24 to read as follows: 10 (24) (A) Every group policy delivered or issued for delivery in this 11 state which provides coverage or reimbursement for dental services which 12 includes coverage for restorative dental services shall provide coverage 13 for medically necessary endodontic services performed by a licensed 14 dentist acting within the lawful scope of practice, including a licensed 15 endodontist. 16 (B) Such coverage shall include, but not be limited to: 17 (i) diagnostic examinations and evaluations; 18 (ii) specialist consultations; 19 (iii) radiographic and diagnostic imaging; 20 (iv) root canal therapy; 21 (v) endodontic retreatment procedures; 22 (vi) apicoectomy procedures; 23 (vii) emergency endodontic treatment; and 24 (viii) post-treatment care reasonably related to endodontic treatment. 25 (C) An insurer shall not deny coverage for a medically necessary 26 covered service under this paragraph solely because such service is 27 rendered by a licensed endodontist rather than a general dentist. 28 (D) If an insurer does not maintain an adequate network of participat- 29 ing endodontists to ensure reasonable access to covered endodontic 30 services without unreasonable delay, the insurer shall provide coverage 31 for services rendered by a non-participating endodontist at no greater 32 cost-sharing obligation than would apply to services rendered by a 33 participating provider. 34 (E) No policy subject to this paragraph shall impose annual limita- 35 tions, frequency limitations, or utilization review requirements for 36 medically necessary endodontic services that are more restrictive than 37 those applied to other comparable restorative dental services covered 38 under the policy. 39 (F) For purposes of this paragraph, "medically necessary endodontic 40 services" means dental services necessary to diagnose, treat, relieve, 41 or prevent infection, pain, disease, or damage affecting the dental pulp 42 or surrounding tissues, consistent with generally accepted standards of 43 dental practice. 44 § 3. Section 4303 of the insurance law is amended by adding a new 45 subsection (yy) to read as follows: 46 (yy) (1) Every contract issued by a medical expense indemnity corpo- 47 ration, a hospital service corporation or a health service which 48 includes coverage for restorative dental services shall provide coverage 49 for medically necessary endodontic services performed by a licensed 50 dentist acting within the lawful scope of practice, including a licensed 51 endodontist. 52 (2) Such coverage shall include, but not be limited to: 53 (A) diagnostic examinations and evaluations; 54 (B) specialist consultations; 55 (C) radiographic and diagnostic imaging; 56 (D) root canal therapy;S. 10607 3 1 (E) endodontic retreatment procedures; 2 (F) apicoectomy procedures; 3 (G) emergency endodontic treatment; and 4 (H) post-treatment care reasonably related to endodontic treatment. 5 (3) An insurer shall not deny coverage for a medically necessary 6 covered service under this subsection solely because such service is 7 rendered by a licensed endodontist rather than a general dentist. 8 (4) If an insurer does not maintain an adequate network of participat- 9 ing endodontists to ensure reasonable access to covered endodontic 10 services without unreasonable delay, the insurer shall provide coverage 11 for services rendered by a non-participating endodontist at no greater 12 cost-sharing obligation than would apply to services rendered by a 13 participating provider. 14 (5) No policy subject to this subsection shall impose annual limita- 15 tions, frequency limitations, or utilization review requirements for 16 medically necessary endodontic services that are more restrictive than 17 those applied to other comparable restorative dental services covered 18 under the policy. 19 (6) For purposes of this subsection, "medically necessary endodontic 20 services" means dental services necessary to diagnose, treat, relieve, 21 or prevent infection, pain, disease, or damage affecting the dental pulp 22 or surrounding tissues, consistent with generally accepted standards of 23 dental practice. 24 § 4. The superintendent of financial services may promulgate any rules 25 and regulations necessary to implement the provisions of this act, 26 including standards relating to network adequacy for endodontic provid- 27 ers. 28 § 5. This act shall take effect on the one hundred eightieth day after 29 it shall have become a law and shall apply to all policies and contracts 30 issued, renewed, modified, altered or amended on or after such date.
