ADDABBO, AKSHAR, BROOKS, CLEARE, COONEY, HOYLMAN, JACKSON, KENNEDY, KRUEGER, MANNION, MAY, SALAZAR,
SKOUFIS, THOMAS
MLTSPNSR
Amd §§3216, 3221 & 4303, Ins L
Requires any third-party payments, financial assistance, discount, voucher or other price reduction instrument for out-of-pocket expenses made on behalf of an insured individual for the cost of prescription drugs to be applied to the insured's deductible, copayment, coinsurance, out-of-pocket maximum, or any other cost-sharing requirement when calculating such insured individual's overall contribution to any out-of-pocket maximum or any cost-sharing requirement.
STATE OF NEW YORK
________________________________________________________________________
5299--A
Cal. No. 762
2021-2022 Regular Sessions
IN SENATE
March 1, 2021
___________
Introduced by Sens. RIVERA, ADDABBO, AKSHAR, BROOKS, COONEY, HOYLMAN,
JACKSON, KENNEDY, KRUEGER, SALAZAR, SKOUFIS -- read twice and ordered
printed, and when printed to be committed to the Committee on Insur-
ance -- recommitted to the Committee on Insurance in accordance with
Senate Rule 6, sec. 8 -- reported favorably from said committee,
ordered to first and second report, ordered to a third reading,
amended and ordered reprinted, retaining its place in the order of
third reading
AN ACT to amend the insurance law, in relation to calculating an insured
individual's overall contribution to any out-of-pocket maximum or any
cost-sharing requirement
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subsection (i) of section 3216 of the insurance law is
2 amended by adding a new paragraph 37 to read as follows:
3 (37) Any policy that provides coverage for prescription drugs shall
4 apply any third-party payments, financial assistance, discount, voucher
5 or other price reduction instrument for out-of-pocket expenses made on
6 behalf of an insured individual for the cost of prescription drugs to
7 the insured's deductible, copayment, coinsurance, out-of-pocket maximum,
8 or any other cost-sharing requirement when calculating such insured
9 individual's overall contribution to any out-of-pocket maximum or any
10 cost-sharing requirement. If under federal law, application of this
11 requirement would result in health savings account ineligibility under
12 26 USC 223, this requirement shall apply for health savings account-qua-
13 lified high deductible health plans with respect to the deductible of
14 such a plan after the enrollee has satisfied the minimum deductible
15 under 26 USC 223, except for with respect to items or services that are
16 preventive care pursuant to 26 USC 223(c)(2)(C), in which case the
17 requirements of this paragraph shall apply regardless of whether the
18 minimum deductible under 26 USC 223 has been satisfied.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD00472-02-2
S. 5299--A 2
1 § 2. Subsection (l) of section 3221 of the insurance law is amended by
2 adding a new paragraph 21 to read as follows:
3 (21) Every group or blanket policy delivered or issued for delivery in
4 this state that provides coverage for prescription drugs shall apply any
5 third-party payments, financial assistance, discount, voucher or other
6 price reduction instrument for out-of-pocket expenses made on behalf of
7 an insured individual for the cost of prescription drugs to the
8 insured's deductible, copayment, coinsurance, out-of-pocket maximum, or
9 any other cost-sharing requirement when calculating such insured indi-
10 vidual's overall contribution to any out-of-pocket maximum or any cost-
11 sharing requirement. If under federal law, application of this require-
12 ment would result in health savings account ineligibility under 26 USC
13 223, this requirement shall apply for health savings account-qualified
14 high deductible health plans with respect to the deductible of such a
15 plan after the enrollee has satisfied the minimum deductible under 26
16 USC 223, except for with respect to items or services that are preven-
17 tive care pursuant to 26 USC 223(c)(2)(C), in which case the require-
18 ments of this paragraph shall apply regardless of whether the minimum
19 deductible under 26 USC 223 has been satisfied.
20 § 3. Section 4303 of the insurance law is amended by adding a new
21 subsection (tt) to read as follows:
22 (tt) Every contract issued by a medical expense indemnity corporation,
23 hospital service corporation, or health service corporation that
24 provides coverage for prescription drugs shall apply any third-party
25 payments, financial assistance, discount, voucher or other price
26 reduction instrument for out-of-pocket expenses made on behalf of an
27 insured individual for the cost of prescription drugs to the insured's
28 deductible, copayment, coinsurance, out-of-pocket maximum, or any other
29 cost-sharing requirement when calculating such insured individual's
30 overall contribution to any out-of-pocket maximum or any cost-sharing
31 requirement. If under federal law, application of this requirement would
32 result in health savings account ineligibility under 26 USC 223, this
33 requirement shall apply for health savings account-qualified high deduc-
34 tible health plans with respect to the deductible of such a plan after
35 the enrollee has satisfied the minimum deductible under 26 USC 223,
36 except for with respect to items or services that are preventive care
37 pursuant to 26 USC 223(c)(2)(C), in which case the requirements of this
38 paragraph shall apply regardless of whether the minimum deductible under
39 26 USC 223 has been satisfied.
40 § 4. This act shall take effect on the first of January next succeed-
41 ing the date on which it shall have become a law and shall apply to all
42 policies and contracts issued, renewed, modified, altered or amended on
43 or after such date.
