STATE OF NEW YORK ________________________________________________________________________ 3645 2025-2026 Regular Sessions IN ASSEMBLY January 29, 2025 ___________ Introduced by M. of A. SIMONE -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to requiring health insurance policies to include coverage of optional anesthesia for certain contraceptive and menstrual health procedures The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Clause (v) of subparagraph (E) of paragraph 17 of 2 subsection (i) of section 3216 of the insurance law, as amended by 3 section 3 of part M of chapter 57 of the laws of 2019, is amended to 4 read as follows: 5 (v) all FDA-approved menstrual health procedures and contraceptive 6 drugs, devices, and other products, including all over-the-counter 7 contraceptive drugs, devices, and products as prescribed or as otherwise 8 authorized under state or federal law; voluntary sterilization proce- 9 dures pursuant to 42 U.S.C. 18022 and identified in the comprehensive 10 guidelines supported by the health resources and services administration 11 and thereby incorporated in the essential health benefits benchmark 12 plan; patient education and counseling on contraception; and follow-up 13 services related to the drugs, devices, products, and procedures covered 14 under this clause, including, but not limited to, management of side 15 effects, counseling for continued adherence, and device insertion and 16 removal. Except as otherwise authorized under this clause, a contract 17 shall not impose any restrictions or delays on the coverage required 18 under this clause. However, where the FDA has approved one or more 19 therapeutic and pharmaceutical equivalent, as defined by the FDA, 20 versions of a contraceptive drug, device, or product, a contract is not 21 required to include all such therapeutic and pharmaceutical equivalent 22 versions in its formulary, so long as at least one is included and 23 covered without cost-sharing and in accordance with this clause. If the 24 covered therapeutic and pharmaceutical equivalent versions of a drug, EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01380-01-5
A. 3645 2 1 device, or product are not available or are deemed medically inadvisable 2 a contract shall provide coverage for an alternate therapeutic and phar- 3 maceutical equivalent version of the contraceptive drug, device, or 4 product without cost-sharing. (a) This coverage shall include emergency 5 contraception without cost sharing when provided pursuant to a 6 prescription, or order under section sixty-eight hundred thirty-one of 7 the education law or when lawfully provided over-the-counter. (b) If the 8 attending health care provider, in [his or her] their reasonable profes- 9 sional judgment, determines that the use of a non-covered therapeutic or 10 pharmaceutical equivalent of a drug, device, or product is warranted, 11 the health care provider's determination shall be final. The superinten- 12 dent shall promulgate regulations establishing a process, including 13 timeframes, for an insured, an insured's designee or an insured's health 14 care provider to request coverage of a non-covered contraceptive drug, 15 device, or product. Such regulations shall include a requirement that 16 insurers use an exception form that shall meet criteria established by 17 the superintendent. (c) This coverage must allow for the dispensing of 18 up to twelve months worth of a contraceptive at one time. (d) This 19 coverage shall include optional anesthesia for vaginal, cervical, and 20 uterine medical procedures, including, but not limited to, loop electro- 21 surgical excision procedure, colposcopy, ablation, and intrauterine 22 device insertion. (e) For the purposes of this clause, "over-the-counter 23 contraceptive products" shall mean those products provided for in 24 comprehensive guidelines supported by the health resources and services 25 administration as of January twenty-first, two thousand nineteen. 26 § 2. Subparagraph (A) of paragraph 16 of subsection (l) of section 27 3221 of the insurance law, as amended by section 1 of part M of chapter 28 57 of the laws of 2019, is amended to read as follows: 29 (A) Every group or blanket policy that provides medical, major 30 medical, or similar comprehensive type coverage that is issued, amended, 31 renewed, effective or delivered on or after January first, two thousand 32 twenty, shall provide coverage for all of the following services, 33 menstrual health procedures, and contraceptive methods: 34 (1) All FDA-approved menstrual health procedures and contraceptive 35 drugs, devices, and other products. This includes all FDA-approved 36 over-the-counter contraceptive drugs, devices, and products as 37 prescribed or as otherwise authorized under state or federal law. The 38 following applies to this coverage: 39 (a) where the FDA has approved one or more therapeutic and pharmaceu- 40 tical equivalent, as defined by the FDA, versions of a contraceptive 41 drug, device, or product, a group or blanket policy is not required to 42 include all such therapeutic and pharmaceutical equivalent versions in 43 its formulary, so long as at least one is included and covered without 44 cost-sharing and in accordance with this paragraph; 45 (b) if the covered therapeutic and pharmaceutical equivalent versions 46 of a drug, device, or product are not available or are deemed medically 47 inadvisable a group or blanket policy shall provide coverage for an 48 alternate therapeutic and pharmaceutical equivalent version of the 49 contraceptive drug, device, or product without cost-sharing. If the 50 attending health care provider, in [his or her] their reasonable profes- 51 sional judgment, determines that the use of a non-covered therapeutic or 52 pharmaceutical equivalent of a drug, device, or product is warranted, 53 the health care provider's determination shall be final. The superinten- 54 dent shall promulgate regulations establishing a process, including 55 timeframes, for an insured, an insured's designee or an insured's health 56 care provider to request coverage of a non-covered contraceptive drug,
A. 3645 3 1 device, or product. Such regulations shall include a requirement that 2 insurers use an exception form that shall meet criteria established by 3 the superintendent; 4 (c) this coverage shall include emergency contraception without cost- 5 sharing when provided pursuant to a prescription or order under section 6 sixty-eight hundred thirty-one of the education law or when lawfully 7 provided over the counter; [and] 8 (d) this coverage must allow for the dispensing of up to twelve months 9 worth of a contraceptive at one time; and 10 (e) this coverage shall include optional anesthesia for vaginal, 11 cervical, and uterine medical procedures, including, but not limited to, 12 loop electrosurgical excision procedure, colposcopy, ablation, and 13 intrauterine device insertion; 14 (2) Voluntary sterilization procedures pursuant to 42 U.S.C. 18022 and 15 identified in the comprehensive guidelines supported by the health 16 resources and services administration and thereby incorporated in the 17 essential health benefits benchmark plan; 18 (3) Patient education and counseling on contraception; and 19 (4) Follow-up services related to the drugs, devices, products, and 20 procedures covered under this paragraph, including, but not limited to, 21 management of side effects, counseling for continued adherence, and 22 device insertion and removal. 23 § 3. The opening paragraph and subparagraph (A) of paragraph 1 of 24 subsection (cc) of section 4303 of the insurance law, as amended by 25 section 2 of part M of chapter 57 of the laws of 2019, are amended to 26 read as follows: 27 Every contract that provides medical, major medical, or similar 28 comprehensive type coverage that is issued, amended, renewed, effective 29 or delivered on or after January first, two thousand twenty, shall 30 provide coverage for all of the following services, menstrual health 31 procedures, and contraceptive methods: 32 (A) All FDA-approved menstrual health procedures and contraceptive 33 drugs, devices, and other products. This includes all FDA-approved 34 over-the-counter contraceptive drugs, devices, and products as 35 prescribed or as otherwise authorized under state or federal law. The 36 following applies to this coverage: 37 (i) where the FDA has approved one or more therapeutic and pharmaceu- 38 tical equivalent, as defined by the FDA, versions of a contraceptive 39 drug, device, or product, a contract is not required to include all such 40 therapeutic and pharmaceutical equivalent versions in its formulary, so 41 long as at least one is included and covered without cost-sharing and in 42 accordance with this subsection; 43 (ii) if the covered therapeutic and pharmaceutical equivalent versions 44 of a drug, device, or product are not available or are deemed medically 45 inadvisable a contract shall provide coverage for an alternate therapeu- 46 tic and pharmaceutical equivalent version of the contraceptive drug, 47 device, or product without cost-sharing. If the attending health care 48 provider, in [his or her] their reasonable professional judgment, deter- 49 mines that the use of a non-covered therapeutic or pharmaceutical equiv- 50 alent of a drug, device, or product is warranted, the health care 51 provider's determination shall be final. The superintendent shall 52 promulgate regulations establishing a process, including timeframes, for 53 an insured, an insured's designee or an insured's health care provider 54 to request coverage of a non-covered contraceptive drug, device, or 55 product. Such regulations shall include a requirement that insurers use
A. 3645 4 1 an exception form that shall meet criteria established by the super- 2 intendent; 3 (iii) this coverage shall include emergency contraception without 4 cost-sharing when provided pursuant to a prescription or order under 5 section sixty-eight hundred thirty-one of the education law or when 6 lawfully provided over the counter; [and] 7 (iv) this coverage must allow for the dispensing of up to twelve 8 months worth of a contraceptive at one time; and 9 (v) this coverage shall include optional anesthesia for vaginal, 10 cervical, and uterine medical procedures, including, but not limited to, 11 loop electrosurgical excision procedure, colposcopy, ablation, and 12 intrauterine device insertion; 13 § 4. This act shall take effect immediately.