NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7304
SPONSOR: Rosenthal TITLE OF BILL:
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
PURPOSE:
This bill ensures that children will have access to pediatric vision
care regardless of their family's income level.
SUMMARY OF SPECIFIC PROVISIONS:
Section one amends subparagraphs B and C of paragraph 17 of subsection 1
of section 3216 of the insurance law.
Section two amends subparagraphs B and C of paragraph 8 of subsection 1
on section 3221 of the insurance law.
Section three amends paragraph 2 of subsection j of section 4303 of the
insurance law. Section four establishes the effective date.
JUSTIFICATION:
The American Public Health Association has stated that childhood vision
problems are often treatable with timely diagnosis and access to care,
but children in low-income households face an elevated risk of vision
loss and do not have the same access to treatment. Untreated vision
problems can have wide-ranging effects on children, from negatively
impacting their self-esteem to their performance in school.
Under the Affordable Care Act, pediatric vision care is an Essential
Health Benefit and insurers must provide some level of coverage for
annual eye exams. However, the current level of coverage varies, and
families can still be hit with co-payments that prevent them from
accessing care.
New York State must ensure that all students in the state have access to
vision care, regardless of their family's income or insurance plan. This
legislation will set students up for success by ensuring all children
are eligible to receive an eye exam each calendar year and prohibiting
private insurers from charging co-payments on such exams.
LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATIONS:
Undetermined.
EFFECTIVE DATE:
This act shall take effect on the one hundred eightieth day after it
shall have become law. Effective immediately, the addition, amendment
and/or repeal of any rule or regulation necessary for the implementation
of this act on its effective date are authorized to be made and
completed on or before such effective date.
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.
