New York A 11520: Relates to insurance coverage for endodontic services

Bill Text

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A11520 Summary:

BILL NOA11520 

&nbsp

SAME ASSAME AS S10607

&nbsp

SPONSORRules (Lavine)

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COSPNSR

&nbsp

MLTSPNSR

&nbsp

Amd §§3216, 3221 & 4303, Ins L

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Mandates insurance policies which cover restorative dental services to provide coverage for endodontic services including exams, imaging, root canals and post-treatment care.

Go to top A11520 Actions:

BILL NOA11520 

&nbsp

05/28/2026referred to insurance

Go to topA11520 Committee&nbspVotes:

Go to topA11520 Floor&nbspVotes:

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

Go to topA11520 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 11520

 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, in relation to insurance coverage for
 endodontic services

 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 42 to read as follows:
 3 (42) (A) Every policy which provides coverage or reimbursement for
 4 dental services which includes coverage for restorative dental services
 5 shall provide coverage for medically necessary endodontic services
 6 performed by a licensed dentist acting within the lawful scope of prac-
 7 tice, including a licensed endodontist.
 8 (B) Such coverage shall include, but not be limited to:
 9 (i) diagnostic examinations and evaluations;
 10 (ii) specialist consultations;
 11 (iii) radiographic and diagnostic imaging;
 12 (iv) root canal therapy;
 13 (v) endodontic retreatment procedures;
 14 (vi) apicoectomy procedures;
 15 (vii) emergency endodontic treatment; and
 16 (viii) post-treatment care reasonably related to endodontic treatment.
 17 (C) An insurer shall not deny coverage for a medically necessary
 18 covered service solely because such service is rendered by a licensed
 19 endodontist rather than a general dentist.
 20 (D) If an insurer does not maintain an adequate network of participat-
 21 ing endodontists to ensure reasonable access to covered endodontic
 22 services without unreasonable delay, the insurer shall provide coverage
 23 for services rendered by a non-participating endodontist at no greater
 24 cost-sharing obligation than would apply to services rendered by a
 25 participating provider.
 26 (E) No policy subject to this paragraph shall impose annual limita-
 27 tions, frequency limitations, or utilization review requirements for
 28 medically necessary endodontic services that are more restrictive than

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD15989-01-6

 A. 11520 2

 1 those applied to other comparable restorative dental services covered
 2 under the policy.
 3 (F) For purposes of this paragraph, "medically necessary endodontic
 4 services" means dental services necessary to diagnose, treat, relieve,
 5 or prevent infection, pain, disease, or damage affecting the dental pulp
 6 or surrounding tissues, consistent with generally accepted standards of
 7 dental practice.
 8 § 2. Subsection (l) of section 3221 of the insurance law is amended by
 9 adding a new paragraph 24 to read as follows:
 10 (24) (A) Every group policy delivered or issued for delivery in this
 11 state which provides coverage or reimbursement for dental services which
 12 includes coverage for restorative dental services shall provide coverage
 13 for medically necessary endodontic services performed by a licensed
 14 dentist acting within the lawful scope of practice, including a licensed
 15 endodontist.
 16 (B) Such coverage shall include, but not be limited to:
 17 (i) diagnostic examinations and evaluations;
 18 (ii) specialist consultations;
 19 (iii) radiographic and diagnostic imaging;
 20 (iv) root canal therapy;
 21 (v) endodontic retreatment procedures;
 22 (vi) apicoectomy procedures;
 23 (vii) emergency endodontic treatment; and
 24 (viii) post-treatment care reasonably related to endodontic treatment.
 25 (C) An insurer shall not deny coverage for a medically necessary
 26 covered service under this paragraph solely