How S 6474 changes current law

Compared against the New York Consolidated Laws as published AI-generated reading aid — verify against the official bill.

This bill amends 1 section(s) of the New York Consolidated Laws: Section 3216 of the insurance law.

• Section 3216 of the insurance law

  (5) "Congenital anomaly" means a medically diagnosed condition exist- ing at or from birth that is a deviation from the common structure or function of the body, whether caused by a hereditary or developmental disability or disease. (6) "Cosmetic surgery" means surgical and nonsurgical elective proce- dures that enhance and reshape structures of the body to improve appear- ance and confidence, but are not necessary to improve body structure or function. (7) "Habilitative services" means healthcare services that help an individual keep, learn, or improve skills and functioning for daily living. Habilitative services shall include but is not limited to phys- ical and occupational therapy, speech-language pathology, and services for people with disabilities in a variety of inpatient and/or outpatient settings. (8) "Reconstructive services" means procedures or surgery that are performed to treat structures of the body affected aesthetically or functionally by congenital anomalies, developmental abnormalities, trau- ma, infection, tumors, or disease. Reconstructive services are intended to improve function and ability, and may also be performed to achieve a more typical appearance of the affected structure. italics (9) "Deviation" means an anomaly that impairs the function of the body and includes but is not limited to the conditions of cleft lip, cleft palate, webbed fingers or toes, supernumerary toes or fingers, craniofa- cial malformations, disorders of metabolism, and other conditions that are medically diagnosed to be congenital anomalies. (D) (1) For the purpose of this subparagraph, the term "treatment" includes inpatient and outpatient care and services performed to improve or restore body function, or performed to approximate a normal appear- ance, as a result of a congenital anomaly and shall not include cosmetic surgery. Inpatient and outpatient care and services shall include treat- ment to any and all missing or abnormal body parts, including teeth, the oral cavity, and their associated structures, that would otherwise be provided under the plan or coverage for any other injury and sickness, including: (i) All inpatient and outpatient reconstructive services and proce- dures; (ii) All services, procedures, and adjunctive needs, including but not limited to prosthetics and appliances, resulting from complications; (iii) Adjunctive dental, orthodontic or prosthodontic support from birth until the medical or surgical treatment of the anomaly has been completed, including ongoing or subsequent treatment required to main- tain function or approximate a normal appearance; (iv) Procedures that do not materially restore or improve the function of the body part being treated; and (v) Procedures for secondary conditions and follow-up treatments. (2) (i) Every policy, plan, certificate or contract shall provide benefits for reconstructive services when such treatment is incidental to or follows surgery resulting from injury, sickness or other diseases of the involved missing or abnormal body part or when such treatment is provided to a covered dependent child because of congenital disease or anomaly as determined by the treating physician. (ii) Every policy, plan, certificate or contract shall provide bene- fits for habilitative services when such treatment is incidental to or follows surgery resulting from injury, sickness or other diseases of the involved missing or abnormal body part or when such treatment is provided to a covered dependent child because of congenital disease or anomaly as determined by the treating physician. (iii) Every policy, plan, certificate or contract may be subject to annual deductible, co-payment, and coinsurance provisions as may be deemed appropriate and as are consistent with those established for other benefits under the plan or coverage. (iv) No policy, plan, certificate or contract shall: a. Deny to a patient eligibility or continued eligibility, to enroll or to renew, coverage under the terms

  amended