STATE OF NEW YORK ________________________________________________________________________ 1619 2019-2020 Regular Sessions IN ASSEMBLY January 16, 2019 ___________ Introduced by M. of A. ROZIC, BLAKE, BRONSON, COLTON, CRESPO, D'URSO, DE LA ROSA, ENGLEBRIGHT, BARRETT, FAHY, FERNANDEZ, GUNTHER, ORTIZ, L. ROSENTHAL, D. ROSENTHAL, RIVERA, SIMON, SOLAGES, ABINANTI, JOHNS, RAIA -- Multi-Sponsored by -- M. of A. COOK, CROUCH, GALEF, GIGLIO, M. L. MILLER, NOLAN, RA -- read once and referred to the Committee on Insurance 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. 19 (ii) For purposes of this paragraph, the term "biologically based 20 mental illness" means a mental, nervous, or emotional condition that is 21 caused by a biological disorder of the brain and results in a clinically EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01128-01-9

A. 1619 2 1 significant, psychological syndrome or pattern that substantially limits 2 the functioning of the person with the illness. Such biologically based 3 mental illnesses are defined as schizophrenia/psychotic disorders, major 4 depression, bipolar disorder, delusional disorders, panic disorder, 5 obsessive compulsive disorders[~~, bulimia, and anorexia~~] or an eating 6 disorder. 7 (iii) For purposes of this paragraph, the term "eating disorder" means 8 pica, rumination disorder, avoidant/restrictive food intake disorder, 9 anorexia nervosa, bulimia nervosa, binge eating disorder, other speci- 10 fied feeding or eating disorder, and any other eating disorder contained 11 in the most recent version of the Diagnostic and Statistical Manual of 12 Mental Disorders published by the American Psychiatric Association. 13 § 2. Paragraph 2 of subsection (g) of section 4303 of the insurance 14 law, as amended by chapter 502 of the laws of 2007, is amended to read 15 as follows: 16 (2) (A) A hospital service corporation or a health service corpo- 17 ration, which provides group, group remittance or school blanket cover- 18 age for inpatient hospital care, shall provide comparable coverage for 19 adults and children with biologically based mental illness. Such hospi- 20 tal service corporation or health service corporation shall also provide 21 such comparable coverage for children with serious emotional disturb- 22 ances. Such coverage shall be provided under the terms and conditions 23 otherwise applicable under the contract, including network limitations 24 or variations, exclusions, co-pays, coinsurance, deductibles or other 25 specific cost sharing mechanisms. Provided further, where a contract 26 provides both in-network and out-of-network benefits, the out-of-network 27 benefits may have different coinsurance, co-pays, or deductibles, than 28 the in-network benefits, regardless of whether the contract is written 29 under one license or two licenses. 30 (B) For purposes of this subsection, the term "biologically based 31 mental illness" means a mental, nervous, or emotional condition that is 32 caused by a biological disorder of the brain and results in a clinically 33 significant, psychological syndrome or pattern that substantially limits 34 the functioning of the person with the illness. Such biologically based 35 mental illnesses are defined as schizophrenia/psychotic disorders, major 36 depression, bipolar disorder, delusional disorders, panic disorder, 37 obsessive compulsive disorders[~~, anorexia, and bulimia~~] or an eating 38 disorder. 39 (C) For purposes of this subsection, the term "eating disorder" means 40 pica, rumination disorder, avoidant/restrictive food intake disorder, 41 anorexia nervosa, bulimia nervosa, binge eating disorder, other speci- 42 fied feeding or eating disorder, and any other eating disorder contained 43 in the most recent version of the Diagnostic and Statistical Manual of 44 Mental Disorders published by the American Psychiatric Association. 45 § 3. Paragraph 2 of subsection (h) of section 4303 of the insurance 46 law, as amended by chapter 502 of the laws of 2007, is amended to read 47 as follows: 48 (2) (A) A medical expense indemnity corporation or a health service 49 corporation, which provides group, group remittance or school blanket 50 coverage for physician services, shall provide comparable coverage for 51 adults and children with biologically based mental illness. Such medical 52 expense indemnity corporation or health service corporation shall also 53 provide such comparable coverage for children with serious emotional 54 disturbances. Such coverage shall be provided under the terms and condi- 55 tions otherwise applicable under the contract, including network limita- 56 tions or variations, exclusions, co-pays, coinsurance, deductibles or

A. 1619 3 1 other specific cost sharing mechanisms. Provided further, where a 2 contract provides both in-network and out-of-network benefits, the out- 3 of-network benefits may have different coinsurance, co-pays, or deduct- 4 ibles, than the in-network benefits, regardless of whether the contract 5 is written under one license or two licenses. 6 (B) For purposes of this subsection, the term "biologically based 7 mental illness" means a mental, nervous, or emotional condition that is 8 caused by a biological disorder of the brain and results in a clinically 9 significant, psychological syndrome or pattern that substantially limits 10 the functioning of the person with the illness. Such biologically based 11 mental illnesses are defined as schizophrenia/psychotic disorders, major 12 depression, bipolar disorder, delusional disorders, panic disorder, 13 obsessive compulsive disorder[~~, anorexia, and bulimia~~] or an eating 14 disorder. 15 (C) For purposes of this subsection, the term "eating disorder" means 16 pica, rumination disorder, avoidant/restrictive food intake disorder, 17 anorexia nervosa, bulimia nervosa, binge eating disorder, other speci- 18 fied feeding or eating disorder, and any other eating disorder contained 19 in the most recent version of the Diagnostic and Statistical Manual of 20 Mental Disorders published by the American Psychiatric Association. 21 § 4. This act shall take effect on the ninetieth day after it shall 22 have become a law; provided, however, that the provisions of this act 23 shall apply to policies and contracts issued, renewed, modified, altered 24 or amended on or after such effective date.

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