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A6397Assembly2017-2018 SessionSame asS3171

Cover Cleft Lip Treatment

Official title

“Relates to the mandatory health insurance coverage of cleft lip and cleft palate”

Sponsor Jo Anne SimonAD-52+24 co-sponsorsAffects Finance
Status
In Assembly Committee
Insurance
Impact
6/10
Moderate
Passage
0%

Bill progress

Step 2 of 7

In committee · Insurance

What's happening

This bill requires all health insurance policies in New York to cover treatment for cleft lip and cleft palate, including related conditions.

Why it matters

  1. Ensures comprehensive care for affected individuals. The bill mandates insurance coverage not only for initial surgeries but also for ongoing assessment, evaluation, treatment, management, and follow-up care, recognizing that cleft lip and palate require long-term, multidisciplinary medical attention.

  2. Addresses related and secondary conditions. By requiring coverage for any condition or illness that is related to or develops as a result of a cleft lip or palate, the bill acknowledges the complex medical, dental, hearing, speech, and psychological needs that often accompany these diagnoses.

  3. Eliminates insurer denials based on "cosmetic" grounds. The bill forbids insurance companies from denying coverage for cleft-related treatments by labeling them as merely cosmetic or not functionally necessary, addressing a common barrier that has prevented many patients from receiving essential care.

  4. Standardizes coverage across all policy types. By amending multiple sections of the insurance law, the bill ensures this mandate applies to all major forms of health coverage in New York, reducing disparities and confusion for families seeking necessary treatment.

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Who cares

Headline styles

Cover Cleft Lip Treatment

Plain English, a few words. Used as the page title.

Sponsors

Primary sponsor
Jo Anne Simon

Assembly Member · Assembly District 52

Chair, Mental Health

History

  1. Referred to insurance
  2. Print number 6397a
  3. Amend and recommit to insurance
  4. Referred to insurance

Companion bill

The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.

S3171Senate

Cover Cleft Lip Treatment

In Senate Committee · Insurance · Sponsor Betty Little

Impact 6 · Moderate0% to pass

Full text

2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗

STATE OF NEW YORK

6397--A

2017-2018 Regular Sessions

IN ASSEMBLY

March 6, 2017

Introduced by M. of A. SIMON, MORELLE, McDONOUGH, STEC, M. G. MILLER, HARRIS, KEARNS, LAVINE, MOSLEY, TITONE, ROSENTHAL, GOTTFRIED, BICHOTTE, JAFFEE, ZEBROWSKI, GUNTHER, GALEF, JENNE, D'URSO, NIOU, GRAF, MONTESANO, SEPULVEDA, COOK, HUNTER, CARROLL, McDONALD, GJONAJ, PALUMBO -- Multi-Sponsored by -- M. of A. BRAUNSTEIN, COLTON, ENGLE- BRIGHT, GIGLIO, HOOPER, HYNDMAN, LUPARDO -- read once and referred 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 mandatory health insurance coverage for cleft lip and cleft palate

The People of the State of New York, represented in Senate and Assembly, do enact as follows:

Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 34 to read as follows:

(34) Every policy which provides medical, major medical, or similar comprehensive-type coverage shall include coverage for the assessment, evaluation, treatment, management, and follow-up care of cleft lip and cleft palate. Such coverage shall include but not be limited to treatment for any condition or illness which is related to or developed as a result of cleft lip and/or palate. Coverage shall not be denied on the ground that it is for cosmetic purposes or is not for a functional defect or impairment.

§ 2. Subsection (l) of section 3221 of the insurance law is amended by adding a new paragraph 20 to read as follows:

(20) Every policy which provides medical, major medical, or similar comprehensive-type coverage shall include coverage for the assessment, evaluation, treatment, management, and follow-up care of cleft lip and cleft palate. Such coverage shall include but not be limited to treatment for any condition or illness which is related to or developed as a result of cleft lip and/or palate. Coverage shall not be denied on the

EXPLANATION--Matter in italics (underscored) is new; matter in brackets

[ ] is old law to be omitted.

LBD06145-02-7

A. 6397--A 2

ground that it is for cosmetic purposes or is not for a functional defect or impairment.

§ 3. Section 4303 of the insurance law is amended by adding a new subsection (oo) to read as follows:

(oo) Every policy which provides medical, major medical, or similar comprehensive-type coverage shall include coverage for the assessment, evaluation, treatment, management, and follow-up care of cleft lip and cleft palate. Such coverage shall include but not be limited to treatment for any condition or illness which is related to or developed as a result of cleft lip and/or palate. Coverage shall not be denied on the ground that it is for cosmetic purposes or is not for a functional defect or impairment.

§ 4. This act shall take effect on the ninetieth day after it shall have become a law and shall apply to policies and contracts issued, renewed, modified, altered or amended on or after such date.

Reflowed for reading: line numbers and page breaks removed. Cite the official text.

Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.