What's happening
This bill expands insurance coverage for eating disorders in New York by updating definitions and requiring inclusion of all DSM-recognized eating disorders.
Why it matters
Expands insurance coverage to include all eating disorders recognized by the latest DSM. , not just anorexia and bulimia—ensuring individuals with less commonly known conditions (like binge eating disorder, pica, or avoidant/restrictive food intake disorder) are also covered.
Aligns insurance definitions with current medical standards. , requiring insurers to continually update coverage as the Diagnostic and Statistical Manual of Mental Disorders (DSM) evolves—keeping benefits relevant as psychiatric science advances.
Reduces potential gaps or ambiguity in insurance coverage for mental health. , making it harder for insurers to deny claims based on outdated or narrowly defined lists of covered conditions.
Potentially increases access to early intervention and treatment for a wider range of eating disorders. , which could improve health outcomes and lower long-term healthcare costs by addressing these conditions before they become severe or chronic.
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Who cares
Headline styles
Expand Eating Disorder Coverage
Plain English, a few words. Used as the page title.
Sponsors
History
- Print number 6045c
- Amend and recommit to insurance
- Referred to insurance
- Print number 6045b
- Amend and recommit to insurance
- Print number 6045a
- Amend and recommit to insurance
- 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.
Cover Eating Disorders
In Senate Committee · Insurance · Sponsor Nily Rozic
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
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 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 -- 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 Assembly, do enact as follows:
Section 1. Subparagraph (B) of paragraph 5 of subsection (1) of section 3221 of the insurance law, as amended by chapter 502 of the laws of 2007, is amended to read as follows:
(B) (i) Every insurer delivering a group or school blanket policy or issuing a group or school blanket policy for delivery, in this state, which provides coverage for inpatient hospital care or coverage for physician services, shall provide comparable coverage for adults and children with biologically based mental illness. Such group policies issued or delivered in this state shall also provide such comparable coverage for children with serious emotional disturbances. Such coverage shall be provided under the terms and conditions otherwise applicable under the policy, including network limitations or variations, exclusions, co-pays, coinsurance, deductibles or other specific cost sharing mechanisms. Provided further, where a policy provides both in-network and out-of-network benefits, the out-of-network benefits may have different coinsurance, co-pays, or deductibles, than the in-network benefits, regardless of whether the policy is written under one license 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
(ii) For purposes of this paragraph, the term "biologically based mental illness" means a mental, nervous, or emotional condition that is caused by a biological disorder of the brain and results in a clinically significant, psychological syndrome or pattern that substantially limits the functioning of the person with the illness. Such biologically based mental illnesses are defined as schizophrenia/psychotic disorders, major depression, bipolar disorder, delusional disorders, panic disorder, obsessive compulsive disorders[, bulimia, and anorexia] or an eating disorder.
(iii) For purposes of this paragraph, the term "eating disorder" means pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding or eating disorder, and any other eating disorder contained in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.
§ 2. Paragraph 2 of subsection (g) of section 4303 of the insurance law, as amended by chapter 502 of the laws of 2007, is amended to read as follows:
(2) (A) A hospital service corporation or a health service corporation, which provides group, group remittance or school blanket coverage for inpatient hospital care, shall provide comparable coverage for adults and children with biologically based mental illness. Such hospital service corporation or health service corporation shall also provide such comparable coverage for children with serious emotional disturbances. Such coverage shall be provided under the terms and conditions otherwise applicable under the contract, including network limitations or variations, exclusions, co-pays, coinsurance, deductibles or other specific cost sharing mechanisms. Provided further, where a contract provides both in-network and out-of-network benefits, the out-of-network benefits may have different coinsurance, co-pays, or deductibles, than the in-network benefits, regardless of whether the contract is written under one license or two licenses.
(B) For purposes of this subsection, the term "biologically based mental illness" means a mental, nervous, or emotional condition that is caused by a biological disorder of the brain and results in a clinically significant, psychological syndrome or pattern that substantially limits the functioning of the person with the illness. Such biologically based mental illnesses are defined as schizophrenia/psychotic disorders, major depression, bipolar disorder, delusional disorders, panic disorder, obsessive compulsive disorders[, anorexia, and bulimia] or an eating disorder.
(C) For purposes of this subsection, the term "eating disorder" means pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding or eating disorder, and any other eating disorder contained in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.
§ 3. Paragraph 2 of subsection (h) of section 4303 of the insurance law, as amended by chapter 502 of the laws of 2007, is amended to read as follows:
(2) (A) A medical expense indemnity corporation or a health service corporation, which provides group, group remittance or school blanket coverage for physician services, shall provide comparable coverage for adults and children with biologically based mental illness. Such medical expense indemnity corporation or health service corporation shall also provide such comparable coverage for children with serious emotional
S. 6045--C 3
disturbances. Such coverage shall be provided under the terms and conditions otherwise applicable under the contract, including network limitations or variations, exclusions, co-pays, coinsurance, deductibles or other specific cost sharing mechanisms. Provided further, where a contract provides both in-network and out-of-network benefits, the outof-network benefits may have different coinsurance, co-pays, or deductibles, than the in-network benefits, regardless of whether the contract is written under one license or two licenses.
(B) For purposes of this subsection, the term "biologically based mental illness" means a mental, nervous, or emotional condition that is caused by a biological disorder of the brain and results in a clinically significant, psychological syndrome or pattern that substantially limits the functioning of the person with the illness. Such biologically based mental illnesses are defined as schizophrenia/psychotic disorders, major depression, bipolar disorder, delusional disorders, panic disorder, obsessive compulsive disorder[, anorexia, and bulimia] or an eating disorder.
(C) For purposes of this subsection, the term "eating disorder" means pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding or eating disorder, and any other eating disorder contained in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.
§ 4. This act shall take effect on the ninetieth day after it shall have become a law; provided, however, that the provisions of this act shall apply to policies and contracts issued, renewed, modified, altered or amended on or after such effective date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to coverage for eating disorders
Purpose
This legislation closes a gap in coverage by requiring insurance compa- nies to provide full coverage for all the aspects of eating disorders treatment.
Summary of provisions
Sections I amends subparagraph (b) of paragraph 5 of subsection (1) of section 3221 of the insurance law to require insurers in the state to provide coverage for inpatient hospital care and physician services for eating disorders. The term "eating disorder" is defined.
Section II amends paragraph 2 of subsection (g) of section 4303 of the insurance law to require hospital service and health service corpo- rations to provide coverage for eating disorders. The term "eating disorder" is defined.
Section III amends paragraph 2 of subsection (h) of section 4303 to require medical expense indemnity corporations and health service corpo- rations which provide group, group remittance, or school blanket cover- age for physician services to provide coverage for eating disorders. The term "eating disorder" is defined.
Section IV sets forth the effective date.
Justification
In the United States, 30 million women and men will suffer from a clin- ically significant eating disorder at some time in their life, including anorexia nervosa, bulimia nervosa, binge eating disorder, or other spec- ified feeding or eating disorder (OSFED). Eating disorders are real, complex, and devastating conditions that can have serious consequences for health, productivity, and relationships, and can impact every organ system in the body. Eating disorders are serious, potentially life- threatening conditions that affect a person's emotional and physical health. They are not a fad, phase or lifestyle choice.
People struggling with an eating disorder need to seek professional help. Eating Disorders have the highest mortality rate of any mental illness. For females between fifteen to twenty-four years old who suffer from anorexia nervosa, the mortality rate associated with the illness is twelve times higher than the death rate of all other causes of death. However, with proper medical care, eating disorders are highly treata- ble. The earlier a person with an eating disorder receives treatment, the greater the likelihood of physical and emotional recovery.
Treatment for an eating disorder can cost up to $30,000 per month. Despite the severity of these conditions, insurance coverage can be difficult to obtain, and many families are often forced to choose between bankruptcy and saving a loved one's life. Despite mental health parity laws, many insurance companies continue to deny coverage for an eating disorder, often times because they do not have a solid under- standing of what kind of care a patient requires in order to reach full recovery. The proposed legislation would help ensure New York residents have access to adequate healthcare coverage for eating disorders, decreasing the chance of chronic illness and death.
Legislative history
2017: A06396B (Rozic) - Passed Assembly
Fiscal impact to the state
To be determined.
Effective date
This act shall take effect on the ninetieth day after it shall have become a law; provided, however, that the provisions of this act shall apply to policies and contracts issued, renewed, modified, altered, or amended on or after such effective date.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.