Relates to health insurance coverage for maternity care expenses incurred by adoptive parents

6 Co-sponsors

• Ruben Diaz
• Kemp Hannon
• William J. Larkin Jr.
• Thomas P. Morahan
• Kevin S. Parker
• Dean G. Skelos

Title of bill

An act to amend the insurance law, in relation to health insurance coverage for maternity care expenses incurred by adoptive parents

Purpose

To require health insurers to reimburse adoptive parents for the medical expenses of the biological mother and child when adopting a child.

Summary of provisions

This legislation stipulates that health insurance policies shall provide reimbursement to the adoptive parents for the medical costs of any birth mother and child legally adopted by the insured if: 1) the biological mother is uninsured at the time of birth and gives birth in the U.S. and payment has been made to the provider(s) of services by or on behalf of the policyholder;

2) a sworn statement is submitted by the biological mother that she does not have public or private insurance coverage for prenatal care, and primary and preventive care during the period of pregnancy and birth;

3) the child is placed for adoption within six months of the birth and the policyholder notifies the insurer in writing of the adoption;

4) the policyholder files with the insurer prior to seeking reimbursement court documentation of the adoption; and

5) the policyholder submits written documentation of all medical expenses incurred with respect to the biological mother and the child prior to, at the time of, and following the birth.

Any reimbursement made pursuant to this chapter would be in an amount equal to either (1) the amount that would have been paid had services been provided within an insurer's network or participating providers, or (2) in the case where subscribers may receive services outside of a network, the usual or customary reimbursement would apply.

Existing law

Paragraph 10 of subsection (i) of section 3216 of the insurance law is amended by adding a new subparagraph (c). Paragraph 5 of subsection (k) of section 3221 of the insurance law is amended by adding a new subparagraph (c). Subsection (c) of section 4303 of the insurance law is amended by adding a new paragraph (3).

Justification

Parents who give birth to children and have health insurance are covered by their insurance companies for the mother's medical expenses incurred in conjunction with the birth of her child. Adoptive parents with health insurance coverage are paying for maternity benefits that they cannot directly use. Often, they are also paying out of pocket for the biological mother's medical expenses. This bill would simply allow families who are adopting to use their health insurance to pay for the medical costs associated with the birth of a child who is about to become a part of their family. The bill would also have the effect of encouraging adoptions by eliminating some of the financial obstacles associated with them.

Legislative history

2007-08, S.3300; 2005-06, S.717; 2003-04, S.1774; 1999-2000, S.2772-A; S.2838-A, 1997-98; S.7211, 1996; S.2196, 1995.

Fiscal implications

None.

Effective date

This act shall take effect on the first day of January next succeeding the date on which it shall have become a law and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such date.