STATE OF NEW YORK
________________________________________________________________________
6045--C
2017-2018 Regular Sessions
IN SENATE
May 10, 2017
___________
Introduced by Sens. MARCHIONE, ALCANTARA, BRESLIN, CARLUCCI, FUNKE,
HOYLMAN, KAMINSKY, LANZA, RANZENHOFER -- read twice and ordered print-
ed, and when printed to be committed to the Committee on Insurance --
committee discharged, bill amended, ordered reprinted as amended and
recommitted to said committee -- committee discharged, bill amended,
ordered reprinted as amended and recommitted to said committee --
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 coverage for eating
disorders
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subparagraph (B) of paragraph 5 of subsection (1) of
2 section 3221 of the insurance law, as amended by chapter 502 of the laws
3 of 2007, is amended to read as follows:
4 (B) (i) Every insurer delivering a group or school blanket policy or
5 issuing a group or school blanket policy for delivery, in this state,
6 which provides coverage for inpatient hospital care or coverage for
7 physician services, shall provide comparable coverage for adults and
8 children with biologically based mental illness. Such group policies
9 issued or delivered in this state shall also provide such comparable
10 coverage for children with serious emotional disturbances. Such coverage
11 shall be provided under the terms and conditions otherwise applicable
12 under the policy, including network limitations or variations, exclu-
13 sions, co-pays, coinsurance, deductibles or other specific cost sharing
14 mechanisms. Provided further, where a policy provides both in-network
15 and out-of-network benefits, the out-of-network benefits may have
16 different coinsurance, co-pays, or deductibles, than the in-network
17 benefits, regardless of whether the policy is written under one license
18 or two licenses.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD06526-07-8
S. 6045--C 2
1 (ii) For purposes of this paragraph, the term "biologically based
2 mental illness" means a mental, nervous, or emotional condition that is
3 caused by a biological disorder of the brain and results in a clinically
4 significant, psychological syndrome or pattern that substantially limits
5 the functioning of the person with the illness. Such biologically based
6 mental illnesses are defined as schizophrenia/psychotic disorders, major
7 depression, bipolar disorder, delusional disorders, panic disorder,
8 obsessive compulsive disorders[, bulimia, and anorexia] or an eating
9 disorder.
10 (iii) For purposes of this paragraph, the term "eating disorder" means
11 pica, rumination disorder, avoidant/restrictive food intake disorder,
12 anorexia nervosa, bulimia nervosa, binge eating disorder, other speci-
13 fied feeding or eating disorder, and any other eating disorder contained
14 in the most recent version of the Diagnostic and Statistical Manual of
15 Mental Disorders published by the American Psychiatric Association.
16 § 2. Paragraph 2 of subsection (g) of section 4303 of the insurance
17 law, as amended by chapter 502 of the laws of 2007, is amended to read
18 as follows:
19 (2) (A) A hospital service corporation or a health service corpo-
20 ration, which provides group, group remittance or school blanket cover-
21 age for inpatient hospital care, shall provide comparable coverage for
22 adults and children with biologically based mental illness. Such hospi-
23 tal service corporation or health service corporation shall also provide
24 such comparable coverage for children with serious emotional disturb-
25 ances. Such coverage shall be provided under the terms and conditions
26 otherwise applicable under the contract, including network limitations
27 or variations, exclusions, co-pays, coinsurance, deductibles or other
28 specific cost sharing mechanisms. Provided further, where a contract
29 provides both in-network and out-of-network benefits, the out-of-network
30 benefits may have different coinsurance, co-pays, or deductibles, than
31 the in-network benefits, regardless of whether the contract is written
32 under one license or two licenses.
33 (B) For purposes of this subsection, the term "biologically based
34 mental illness" means a mental, nervous, or emotional condition that is
35 caused by a biological disorder of the brain and results in a clinically
36 significant, psychological syndrome or pattern that substantially limits
37 the functioning of the person with the illness. Such biologically based
38 mental illnesses are defined as schizophrenia/psychotic disorders, major
39 depression, bipolar disorder, delusional disorders, panic disorder,
40 obsessive compulsive disorders[, anorexia, and bulimia] or an eating
41 disorder.
42 (C) For purposes of this subsection, the term "eating disorder" means
43 pica, rumination disorder, avoidant/restrictive food intake disorder,
44 anorexia nervosa, bulimia nervosa, binge eating disorder, other speci-
45 fied feeding or eating disorder, and any other eating disorder contained
46 in the most recent version of the Diagnostic and Statistical Manual of
47 Mental Disorders published by the American Psychiatric Association.
48 § 3. Paragraph 2 of subsection (h) of section 4303 of the insurance
49 law, as amended by chapter 502 of the laws of 2007, is amended to read
50 as follows:
51 (2) (A) A medical expense indemnity corporation or a health service
52 corporation, which provides group, group remittance or school blanket
53 coverage for physician services, shall provide comparable coverage for
54 adults and children with biologically based mental illness. Such medical
55 expense indemnity corporation or health service corporation shall also
56 provide such comparable coverage for children with serious emotional
S. 6045--C 3
1 disturbances. Such coverage shall be provided under the terms and condi-
2 tions otherwise applicable under the contract, including network limita-
3 tions or variations, exclusions, co-pays, coinsurance, deductibles or
4 other specific cost sharing mechanisms. Provided further, where a
5 contract provides both in-network and out-of-network benefits, the out-
6 of-network benefits may have different coinsurance, co-pays, or deduct-
7 ibles, than the in-network benefits, regardless of whether the contract
8 is written under one license or two licenses.
9 (B) For purposes of this subsection, the term "biologically based
10 mental illness" means a mental, nervous, or emotional condition that is
11 caused by a biological disorder of the brain and results in a clinically
12 significant, psychological syndrome or pattern that substantially limits
13 the functioning of the person with the illness. Such biologically based
14 mental illnesses are defined as schizophrenia/psychotic disorders, major
15 depression, bipolar disorder, delusional disorders, panic disorder,
16 obsessive compulsive disorder[, anorexia, and bulimia] or an eating
17 disorder.
18 (C) For purposes of this subsection, the term "eating disorder" means
19 pica, rumination disorder, avoidant/restrictive food intake disorder,
20 anorexia nervosa, bulimia nervosa, binge eating disorder, other speci-
21 fied feeding or eating disorder, and any other eating disorder contained
22 in the most recent version of the Diagnostic and Statistical Manual of
23 Mental Disorders published by the American Psychiatric Association.
24 § 4. This act shall take effect on the ninetieth day after it shall
25 have become a law; provided, however, that the provisions of this act
26 shall apply to policies and contracts issued, renewed, modified, altered
27 or amended on or after such effective date.