Includes tobacco dependence treatments as covered services for certain insureds, policyholders or enrollees

BILL NUMBER:S5750

Title of bill

An act to amend the insurance law, the social services law and the public health law, in relation to including tobacco dependence treatments as covered services for certain insureds, policyholders or enrollees

Purpose

This bill will diminish the statewide economic personal cost of tobacco addiction by making tobacco cessation treatments more available to smokers.

Summary of provisions

Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 28 wherein every policy which provides major-medical or similar comprehensive type coverage shall provide coverage for tobacco cessation services that follow recommendations in the United States Public Health Service guidelines for tobacco cessation and are recommended by a licensed health care professional. Such coverage shall include at least two courses of treatment in a 12-month period including telephone, group and individual counseling, No co-payment shall be applied to benefits under this section. No lifetime limits shall be applied. An insurer shall disclose the benefits under this section in its evidence of coverage and disclosure forms and communicate the availability of coverage to all insureds at least once per year.

Subsection (1) of section 3221 of the insurance law is amended by adding a new paragraph 18 which allows any insurer delivering a group or blanket policy for delivery in this state shall provide coverage for tobacco cessation services that follow recommendations in the United States Public Health Service guidelines for tobacco cessation and are recommended by a licensed health care professional.

Section 4303 of the insurance law is amended by adding a new subsection (hh) wherein any policy issued by a medical expense indemnity corporation, a hospital service corporation or a health services corporation shall provide coverage for tobacco cessation services that follow recommendations in the United States Public Health Service guidelines for tobacco cessation and are recommended by a licensed health care professional.

§4. If any clause, subparagraph, subsection, section or other part of this act, or the application thereof be held to be invalid, such holding shall not affect, impair or invalidate the remainder of this act, or the application of such section held invalid.

§5. This act shall take effect one hundred and eighty days after it shall become a law and shall apply to all policies and contracts issued, renewed, altered or amended on or after such effective date.

Justification

More than 70 percent of smokers wish they could quit

tobacco, and each year one of every two smoker's attempts to quit. However, the unassisted successful tobacco quit rate has remained the same at less than five percent. Access to counseling and pharmaceutical benefits doubles the successful quit rate and has achieved quit rates of 25 to 30 percent. Each adult smoker costs employers $1,760 in lost productivity and $1,623 in excess medical expenditures per year. Experience in health plans indicates that access to all cessation services saves four dollars for every dollar invested. Because of member transfers between plans, financial savings and tobacco-related disease reductions are effective only if universally available to the entire insured population. Therefore, a mandate on ail plans and insurers to provide cost-effective treatment is necessary and beneficial.

Legislative history

New Bill.

Fiscal implications

None.

Effective date

This act shall take effect in 60 days.