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S08265 Summary:

BILL NOS08265A
 
SAME ASSAME AS A06314-A
 
SPONSORSUTTON
 
COSPNSRGOUNARDES, MYRIE, WEBER
 
MLTSPNSR
 
Amd §§3221 & 4303, Ins L
 
Requires insurance coverage to backup devices for patients with cochlear implants during the initial implantation and for replacements and upgrades.
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S08265 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         8265--A
 
                               2025-2026 Regular Sessions
 
                    IN SENATE
 
                                      May 28, 2025
                                       ___________
 
        Introduced  by  Sens.  SUTTON, GOUNARDES, MYRIE, WEBER -- read twice and
          ordered printed, and when printed to be committed to the Committee  on
          Insurance  -- committee discharged, bill amended, ordered reprinted as
          amended and recommitted to said committee
 
        AN ACT to amend the insurance law, in  relation  to  ensuring  continued
          access to backup devices for patients with cochlear implants
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Legislative intent. The  legislature  finds  that  cochlear
     2  implants  are  critical  for  patients with hearing loss to maintain the
     3  ability to hear. These devices, which  are  often  life-changing,  allow
     4  individuals to improve their quality of life, integrate fully into their
     5  communities, and perform daily activities. It is essential that individ-
     6  uals  who rely on cochlear implants have continuous access to the neces-
     7  sary backup equipment to  ensure  uninterrupted  use,  including  during
     8  device upgrades and replacements. Currently, backup devices are provided
     9  only  with  the  initial  implantation,  but  are  not made available to
    10  patients upon the upgrade or replacement of the implant after 3-5 years.
    11  This bill seeks to address this gap in  coverage  and  ensure  that  all
    12  patients  requiring  cochlear  implants  have  a backup device available
    13  throughout the duration of their treatment.
    14    § 2.  Subsection (k) of section 3221 of the insurance law  is  amended
    15  by adding a new paragraph 24 to read as follows:
    16    (24)  (A)  Every  large  group  policy  which  provides medical, major
    17  medical, or similar comprehensive-type coverage shall provide the cover-
    18  age for a backup cochlear implant device when  prescribed  by  a  health
    19  care  practitioner  licensed, certified, or authorized under title eight
    20  of the education law, and acting within their lawful scope of practice.
    21    (B) Coverage of the backup device shall be provided  as  long  as  the
    22  insured  is actively using the cochlear implant, and for the duration of
    23  the insured's need for the device, including any necessary upgrades.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD10291-03-5

        S. 8265--A                          2
 
     1    (C) The coverage provided under this paragraph may be subject to annu-
     2  al deductibles, copayments and coinsurance as may be deemed  appropriate
     3  by  the  superintendent  and  shall  be consistent with those imposed on
     4  other similar benefits under the policy.
     5    (D) For the purposes of this paragraph:
     6    (i)  "cochlear implant" means a medical device surgically implanted to
     7  provide hearing to individuals with  severe  to  profound  sensorineural
     8  hearing loss; and
     9    (ii)  "backup  cochlear  implant  device"  means  an additional set of
    10  external components of the cochlear implant, including a  processor,  in
    11  the event that the primary device fails or requires maintenance.
    12    §  3.  Section  4303  of  the insurance law is amended by adding a new
    13  subsection (ww) to read as follows:
    14    (ww) (1) Every  large  group  policy  which  provides  medical,  major
    15  medical, or similar comprehensive-type coverage shall provide the cover-
    16  age  for  a  backup  cochlear implant device when prescribed by a health
    17  care practitioner licensed, certified, or authorized under  title  eight
    18  of the education law, and acting within their lawful scope of practice.
    19    (2)  Coverage  of  the  backup device shall be provided as long as the
    20  insured is actively using the cochlear implant, and for the duration  of
    21  the insured's need for the device, including any necessary upgrades.
    22    (3)  The  coverage  required under this subsection shall be subject to
    23  annual deductibles, copayments and coinsurance as may be  deemed  appro-
    24  priate  by the superintendent and shall be consistent with those imposed
    25  on other similar benefits under the contract.
    26    (4) For the purposes of this subsection:
    27    (A) "cochlear implant" means a medical device surgically implanted  to
    28  provide  hearing  to  individuals  with severe to profound sensorineural
    29  hearing loss; and
    30    (B) "backup cochlear  implant  device"  means  an  additional  set  of
    31  external  components  of the cochlear implant, including a processor, in
    32  the event that the primary device fails or requires maintenance.
    33    § 4. Severability. If any clause,  sentence,  paragraph,  subdivision,
    34  section  or part of this act shall be adjudged by any court of competent
    35  jurisdiction to be invalid, such judgment shall not affect,  impair,  or
    36  invalidate the remainder thereof, but shall be confined in its operation
    37  to the clause, sentence, paragraph, subdivision, section or part thereof
    38  directly  involved  in the controversy in which such judgment shall have
    39  been rendered. It is hereby declared to be the intent of the legislature
    40  that this act would have been enacted even if  such  invalid  provisions
    41  had not been included herein.
    42    § 5. This act shall take effect January 1, 2027 and shall apply to all
    43  policies  and contracts issued, renewed, modified, altered or amended on
    44  or after such date.
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