STATE OF NEW YORK ________________________________________________________________________ 3101 2019-2020 Regular Sessions IN SENATE February 4, 2019 ___________ Introduced by Sen. BIAGGI -- read twice and ordered printed, and when printed to be committed 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 22 significant, psychological syndrome or pattern that substantially limits 23 the functioning of the person with the illness. Such biologically based 24 mental illnesses are defined as schizophrenia/psychotic disorders, major 25 depression, bipolar disorder, delusional disorders, panic disorder, EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01128-01-9

S. 3101 2 1 obsessive compulsive disorders[~~, bulimia, and anorexia~~] or an eating 2 disorder. 3 (iii) For purposes of this paragraph, the term "eating disorder" means 4 pica, rumination disorder, avoidant/restrictive food intake disorder, 5 anorexia nervosa, bulimia nervosa, binge eating disorder, other speci- 6 fied feeding or eating disorder, and any other eating disorder contained 7 in the most recent version of the Diagnostic and Statistical Manual of 8 Mental Disorders published by the American Psychiatric Association. 9 § 2. Paragraph 2 of subsection (g) of section 4303 of the insurance 10 law, as amended by chapter 502 of the laws of 2007, is amended to read 11 as follows: 12 (2) (A) A hospital service corporation or a health service corpo- 13 ration, which provides group, group remittance or school blanket cover- 14 age for inpatient hospital care, shall provide comparable coverage for 15 adults and children with biologically based mental illness. Such hospi- 16 tal service corporation or health service corporation shall also provide 17 such comparable coverage for children with serious emotional disturb- 18 ances. Such coverage shall be provided under the terms and conditions 19 otherwise applicable under the contract, including network limitations 20 or variations, exclusions, co-pays, coinsurance, deductibles or other 21 specific cost sharing mechanisms. Provided further, where a contract 22 provides both in-network and out-of-network benefits, the out-of-network 23 benefits may have different coinsurance, co-pays, or deductibles, than 24 the in-network benefits, regardless of whether the contract is written 25 under one license or two licenses. 26 (B) For purposes of this subsection, the term "biologically based 27 mental illness" means a mental, nervous, or emotional condition that is 28 caused by a biological disorder of the brain and results in a clinically 29 significant, psychological syndrome or pattern that substantially limits 30 the functioning of the person with the illness. Such biologically based 31 mental illnesses are defined as schizophrenia/psychotic disorders, major 32 depression, bipolar disorder, delusional disorders, panic disorder, 33 obsessive compulsive disorders[~~, anorexia, and bulimia~~] or an eating 34 disorder. 35 (C) For purposes of this subsection, the term "eating disorder" means 36 pica, rumination disorder, avoidant/restrictive food intake disorder, 37 anorexia nervosa, bulimia nervosa, binge eating disorder, other speci- 38 fied feeding or eating disorder, and any other eating disorder contained 39 in the most recent version of the Diagnostic and Statistical Manual of 40 Mental Disorders published by the American Psychiatric Association. 41 § 3. Paragraph 2 of subsection (h) of section 4303 of the insurance 42 law, as amended by chapter 502 of the laws of 2007, is amended to read 43 as follows: 44 (2) (A) A medical expense indemnity corporation or a health service 45 corporation, which provides group, group remittance or school blanket 46 coverage for physician services, shall provide comparable coverage for 47 adults and children with biologically based mental illness. Such medical 48 expense indemnity corporation or health service corporation shall also 49 provide such comparable coverage for children with serious emotional 50 disturbances. Such coverage shall be provided under the terms and condi- 51 tions otherwise applicable under the contract, including network limita- 52 tions or variations, exclusions, co-pays, coinsurance, deductibles or 53 other specific cost sharing mechanisms. Provided further, where a 54 contract provides both in-network and out-of-network benefits, the out- 55 of-network benefits may have different coinsurance, co-pays, or deduct-

S. 3101 3 1 ibles, than the in-network benefits, regardless of whether the contract 2 is written under one license or two licenses. 3 (B) For purposes of this subsection, the term "biologically based 4 mental illness" means a mental, nervous, or emotional condition that is 5 caused by a biological disorder of the brain and results in a clinically 6 significant, psychological syndrome or pattern that substantially limits 7 the functioning of the person with the illness. Such biologically based 8 mental illnesses are defined as schizophrenia/psychotic disorders, major 9 depression, bipolar disorder, delusional disorders, panic disorder, 10 obsessive compulsive disorder[~~, anorexia, and bulimia~~] or an eating 11 disorder. 12 (C) For purposes of this subsection, the term "eating disorder" means 13 pica, rumination disorder, avoidant/restrictive food intake disorder, 14 anorexia nervosa, bulimia nervosa, binge eating disorder, other speci- 15 fied feeding or eating disorder, and any other eating disorder contained 16 in the most recent version of the Diagnostic and Statistical Manual of 17 Mental Disorders published by the American Psychiatric Association. 18 § 4. This act shall take effect on the ninetieth day after it shall 19 have become a law; provided, however, that the provisions of this act 20 shall apply to policies and contracts issued, renewed, modified, altered 21 or amended on or after such effective date.

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