STATE OF NEW YORK ________________________________________________________________________ 7304 2025-2026 Regular Sessions IN ASSEMBLY March 25, 2025 ___________ Introduced by M. of A. ROSENTHAL -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to prohibiting private insurers from charging co-payments for an annual pediatric eye exam completed by an optometrist or ophthalmologist The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subparagraphs (B) and (C) of paragraph 17 of subsection (i) 2 of section 3216 of the insurance law, as amended by chapter 219 of the 3 laws of 2011, are amended to read as follows: 4 (B) For the purposes of subparagraphs (A), (C) and (D) of this para- 5 graph, preventive and primary care services means the following services 6 rendered to a covered child of an insured from the date of birth through 7 the attainment of nineteen years; 8 (i) an initial hospital check-up and well-child visits scheduled in 9 accordance with the prevailing clinical standards of a national associ- 10 ation of pediatric physicians designated by the commissioner of health 11 (except for any standard that would limit the specialty or forum of 12 licensure of the practitioner providing the service other than the 13 limits under state law). Coverage for such services rendered shall be 14 provided only to the extent that such services are provided by or under 15 the supervision of a physician, or other professional licensed under 16 article one hundred thirty-nine of the education law whose scope of 17 practice pursuant to such law includes the authority to provide the 18 specified services. Coverage shall be provided for such services 19 rendered in a hospital, as defined in section twenty-eight hundred one 20 of the public health law, or in an office of a physician or other 21 professional licensed under article one hundred thirty-nine of the 22 education law whose scope of practice pursuant to such law includes the 23 authority to provide the specified services; 24 (ii) at each visit, services in accordance with the prevailing clin- 25 ical standards of such designated association, including a medical 26 history, a complete physical examination, developmental assessment, 27 anticipatory guidance, appropriate immunizations and laboratory tests EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD11258-01-5
A. 7304 2 1 which tests are ordered at the time of the visit and performed in the 2 practitioner's office, as authorized by law, or in a clinical laborato- 3 ry; [and] 4 (iii) necessary immunizations, as determined by the superintendent in 5 consultation with the commissioner of health, consisting of at least 6 adequate dosages of vaccine against diphtheria, pertussis, tetanus, 7 polio, measles, rubella, mumps, haemophilus influenzae type b and hepa- 8 titis b, which meet the standards approved by the United States public 9 health service for such biological products[.]; and 10 (iv) a pediatric eye examination by an optometrist or ophthalmologist 11 once every calendar year, regardless of whether or not a period of three 12 hundred sixty-five days has passed since the previous examination. 13 (C) Such coverage required pursuant to subparagraph (A) or (B) of this 14 paragraph shall not be subject to annual deductibles or coinsurance. 15 Coverage required pursuant to clause (iv) of subparagraph (B) of this 16 paragraph shall not be subject to a co-payment. 17 § 2. Subparagraphs (B) and (C) of paragraph 8 of subsection (l) of 18 section 3221 of the insurance law, as amended by chapter 219 of the 19 laws of 2011, is amended to read as follows: 20 (B) In subparagraphs (A), (C) and (D) of this paragraph, preventive 21 and primary care services means the following services rendered to a 22 covered child of an insured from the date of birth through the attain- 23 ment of nineteen years of age: 24 (i) an initial hospital check-up and well-child visits scheduled in 25 accordance with the prevailing clinical standards of a national associ- 26 ation of pediatric physicians designated by the commissioner of health 27 (except for any standard that would limit the specialty or forum of 28 licensure of the practitioner providing the service other than the 29 limits under state law). Coverage for such services rendered shall be 30 provided only to the extent that such services are provided by or under 31 the supervision of a physician, or other professional licensed under 32 article one hundred thirty-nine of the education law whose scope of 33 practice pursuant to such law includes the authority to provide the 34 specified services. Coverage shall be provided for such services 35 rendered in a hospital, as defined in section twenty-eight hundred one 36 of the public health law, or in an office of a physician or other 37 professional licensed under article one hundred thirty-nine of the 38 education law whose scope of practice pursuant to such law includes the 39 authority to provide the specified services; 40 (ii) at each visit, services in accordance with the prevailing clin- 41 ical standards of such designated association, including a medical 42 history, a complete physical examination, developmental assessment, 43 anticipatory guidance, appropriate immunizations and laboratory tests 44 which tests are ordered at the time of the visit and performed in the 45 practitioner's office, as authorized by law, or in a clinical laborato- 46 ry; [and] 47 (iii) necessary immunizations, as determined by the superintendent in 48 consultation with the commissioner of health, consisting of at least 49 adequate dosages of vaccine against diphtheria, pertussis, tetanus, 50 polio, measles, rubella, mumps, haemophilus influenzae type b and hepa- 51 titis b, which meet the standards approved by the United States public 52 health service for such biological products[.]; and 53 (iv) a pediatric eye examination by an optometrist or ophthalmologist 54 once every calendar year, regardless of whether or not a period of three 55 hundred sixty-five days has passed since the previous examination.
A. 7304 3 1 (C) Such coverage required pursuant to subparagraph (A) or (B) of this 2 paragraph shall not be subject to annual deductibles or coinsurance. 3 Coverage required pursuant to clause (iv) of subparagraph (B) of this 4 paragraph shall not be subject to a co-payment. 5 § 3. Paragraph 2 of subsection (j) of section 4303 of the insurance 6 law, as amended by chapter 219 of the laws of 2011, is amended to read 7 as follows: 8 (2) For purposes of this paragraph and paragraph one of this 9 subsection, preventive and primary care services shall mean the follow- 10 ing services rendered to a covered child of a subscriber from the date 11 of birth through the attainment of nineteen years of age: 12 (A) an initial hospital check-up and well-child visits scheduled in 13 accordance with the prevailing clinical standards of a national associ- 14 ation of pediatric physicians designated by the commissioner of health 15 (except for any standard that would limit the specialty or forum of 16 licensure of the practitioner providing the service other than the 17 limits under state law). Coverage for such services rendered shall be 18 provided only to the extent that such services are provided by or under 19 the supervision of a physician, or other professional licensed under 20 article one hundred thirty-nine of the education law whose scope of 21 practice pursuant to such law includes the authority to provide the 22 specified services. Coverage shall be provided for such services 23 rendered in a hospital, as defined in section twenty-eight hundred one 24 of the public health law, or in an office of a physician or other 25 professional licensed under article one hundred thirty-nine of the 26 education law whose scope of practice pursuant to such law includes the 27 authority to provide the specified services, 28 (B) at each visit, services in accordance with the prevailing clinical 29 standards of such designated association, including a medical history, a 30 complete physical examination, developmental assessment, anticipatory 31 guidance, appropriate immunizations and laboratory tests which tests are 32 ordered at the time of the visit and performed in the practitioner's 33 office, as authorized by law, or in a clinical laboratory, [and] 34 (C) necessary immunizations, as determined by the superintendent in 35 consultation with the commissioner of health, consisting of at least 36 adequate dosages of vaccine against diphtheria, pertussis, tetanus, 37 polio, measles, rubella, mumps, haemophilus influenzae type b and hepa- 38 titis b, which meet the standards approved by the United States public 39 health service for such biological products[.], and 40 (D) a pediatric eye examination by an optometrist or ophthalmologist 41 once every calendar year, regardless of whether or not a period of three 42 hundred sixty-five days has passed since the previous examination. 43 (E) Such coverage required pursuant to this paragraph and paragraph 44 one of this subsection shall not be subject to annual deductibles or 45 coinsurance. Coverage required pursuant to subparagraph (D) of this 46 paragraph shall not be subject to a co-payment. 47 [(E)] (F) Such coverage required pursuant to this paragraph and para- 48 graph one of this subsection shall not restrict or eliminate existing 49 coverage provided by the contract. 50 § 4. This act shall take effect on the one hundred eightieth day after 51 it shall have become a law. Effective immediately, the addition, amend- 52 ment and/or repeal of any rule or regulation necessary for the implemen- 53 tation of this act on its effective date are authorized to be made and 54 completed on or before such effective date.