New York A 11517: Relates to insurance coverage for bruxism diagnosis and treatment

Bill Text

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A11517 Summary:

BILL NOA11517 

&nbsp

SAME ASSAME AS S10606

&nbsp

SPONSORRules (Lavine)

&nbsp

COSPNSR

&nbsp

MLTSPNSR

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Amd §§3216, 3221 & 4303, Ins L; amd §365-a, Soc Serv L

&nbsp

Requires policies which provide dental coverage to provide coverage for bruxism diagnosis and treatment, including the cost of occlusal guards; requires medicaid and HMO coverage.

Go to top A11517 Actions:

BILL NOA11517 

&nbsp

05/28/2026referred to insurance

Go to topA11517 Committee&nbspVotes:

Go to topA11517 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topA11517 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 11517

 IN ASSEMBLY

 May 28, 2026
 ___________

 Introduced by COMMITTEE ON RULES -- (at request of M. of A. Lavine) --
 read once and referred to the Committee on Insurance

 AN ACT to amend the insurance law and the social services law, in
 relation to insurance coverage for bruxism diagnosis and treatment

 The People of the State of New York, represented in Senate and Assem-
 bly, do enact as follows:

 1 Section 1. Legislative findings. The legislature hereby finds and
 2 declares that Bruxism is a serious oral health condition that may result
 3 in tooth fracture, enamel erosion, temporomandibular joint disorders,
 4 chronic pain, sleep disruption, and irreversible tooth loss when left
 5 untreated. Early diagnosis and preventative treatment of bruxism
 6 substantially reduces the need for costly restorative dental procedures,
 7 including crowns, implants, dentures, and oral surgery. Current dental
 8 reimbursement practices frequently fail to adequately compensate
 9 dentists for the evaluation, diagnosis, and treatment planning associ-
 10 ated with bruxism and related occlusal disorders, thereby discouraging
 11 preventative intervention. Many dental insurance policies nominally
 12 provide coverage for occlusal guards while imposing reimbursement limi-
 13 tations, utilization barriers, or medical necessity requirements that
 14 render such coverage inaccessible in practice. Low-income individuals,
 15 Medicaid recipients, individuals with disabilities, and underserved
 16 minority communities disproportionately experience barriers to preventa-
 17 tive oral healthcare and are more likely to suffer preventable dental
 18 deterioration and tooth loss due to untreated bruxism. It is therefore
 19 in the public interest to promote preventative oral healthcare by
 20 requiring meaningful reimbursement and coverage for the diagnosis and
 21 treatment of bruxism and related occlusal disorders.
 22 § 2. Subsection (i) of section 3216 of the insurance law is amended by
 23 adding a new paragraph 42 to read as follows:
 24 (42) (A) Every policy which provides coverage or reimbursement for
 25 dental services shall provide coverage or reimbursement for the diagno-
 26 sis and treatment of bruxism and related occlusal disorders when deter-
 27 mined to be medically necessary by a licensed dentist.
 28 (B) Such coverage shall include reimbursement for:

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD15988-01-6

 A. 11517 2

 1 (i) clinical evaluation and screening;
 2 (ii) diagnosis;
 3 (iii) treatment planning;
 4 (iv) follow-up monitoring; and
 5 (v) custom-fabricated occlusal guards or appliances prescribed for the
 6 treatment of diagnosed bruxism or related occlusal disorders.
 7 (C) No insurer shall deny coverage for a prescribed occlusal guard
 8 solely on the basis that the treatment is preventative in nature.
 9 (D) Coverage provided pursuant to this paragraph shall not be subject
 10 to annual or lifetime limitations that are less favorable than those
 11 imposed on other medically necessary dental services.
 12 (E) The superintendent of financial services may promulgate rules and
 13 regulations necessary to implement the provisions of this paragraph,
 14 including standards relating to medical necessity and utilization
 15 review.
 16 § 3. Subsection (l) of section 3221 of the insurance law is amended by
 17 adding a new paragraph 24 to read as follows:
 18 (24) (A) Every group or blanket accident and health insurance policy
 19 issued or issued for delivery in this state whi