New York A 7472: Authorizes health insurers to provide actuarially appropriate reductions in health insurance premiums for participation in a wellness program

Bill Text

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A07472 Summary:

BILL NOA07472 

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SAME ASSAME AS S01198

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SPONSORWeprin

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COSPNSRMeeks, Griffin, Cruz, Lupardo, Septimo, Shrestha

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MLTSPNSR

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Amd §§3216, 4235, 4301 & 4322, Ins L

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Limits co-payments for physical and occupational therapy services.

Go to top A07472 Actions:

BILL NOA07472 

&nbsp

03/28/2025referred to insurance

01/07/2026referred to insurance

Go to topA07472 Committee&nbspVotes:

Go to topA07472 Floor&nbspVotes:

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

Go to topA07472 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 7472

 2025-2026 Regular Sessions

 IN ASSEMBLY

 March 28, 2025
 ___________

 Introduced by M. of A. WEPRIN -- read once and referred to the Committee
 on Insurance

 AN ACT to amend the insurance law, in relation to health insurance
 coverage of physical and occupational therapy services

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

 1 Section 1. Paragraph 23 of subsection (i) of section 3216 of the
 2 insurance law, as added by chapter 593 of the laws of 2000, is amended
 3 to read as follows:
 4 (23) If a policy provides for reimbursement for physical and occupa-
 5 tional therapy service which is within the lawful scope of practice of a
 6 duly licensed physical or occupational therapist, an insured shall be
 7 entitled to reimbursement for such service whether the said service is
 8 performed by a physician or through a duly licensed physical or occupa-
 9 tional therapist, provided however, that nothing contained herein shall
 10 be construed to impair any terms of such policy including appropriate
 11 utilization review and the requirement that said service be performed
 12 pursuant to a medical order, or a similar or related service of a physi-
 13 cian, provided, further, that such terms shall not impose co-payments in
 14 excess of twenty percent of the total reimbursement to the provider of
 15 care.
 16 § 2. Subparagraph (A) of paragraph 1 of subsection (f) of section 4235
 17 of the insurance law, as amended by chapter 219 of the laws of 2011,
 18 item (ii) as amended by chapter 479 of the laws of 2022, is amended to
 19 read as follows:
 20 (A) Any policy of group accident, group health or group accident and
 21 health insurance may include provisions for the payment by the insurer
 22 of benefits for expenses incurred on account of hospital, medical or
 23 surgical care or physical and occupational therapy by licensed physical
 24 and occupational therapists upon the prescription or referral of a
 25 physician for the employee or other member of the insured group, the

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD02927-01-5

 A. 7472 2

 1 employee's or member's spouse, the employee's or member's child or chil-
 2 dren, or other persons chiefly dependent upon the employee or member for
 3 support and maintenance; provided that:
 4 (i) a policy of hospital, medical, surgical, or prescription drug
 5 expense insurance that provides coverage for children shall provide such
 6 coverage to a married or unmarried child until attainment of age twen-
 7 ty-six, without regard to financial dependence, residency with the
 8 employee or member, student status, or employment, except a policy that
 9 is a grandfathered health plan may, for plan years beginning before
 10 January first, two thousand fourteen, exclude coverage of an adult child
 11 under age twenty-six who is eligible to enroll in an employer-sponsored
 12 health plan other than a group health plan of a parent. For purposes of
 13 this item, "grandfathered health plan" means coverage provided by an
 14 insurer in which an individual was enrolled on March twenty-third, two
 15 thousand ten for as long as the coverage maintains grandfathered status
 16 in accordance with section 1251(e) of the Affordable Care Act, 42 U.S.C.
 17 § 18011(e); [and]
 18 (ii) a policy under which coverage terminates at a specified age shall
 19 not so terminate with respect to an unmarried child who is incapable of
 20 self-sustaining employment by reason of mental illness, developmental
 21 disability, as defined in the mental hygiene law, or physi