A 11520 —

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

  (42) (A) Every policy which provides coverage or reimbursement for dental services which includes coverage for restorative dental services shall provide coverage for medically necessary endodontic services performed by a licensed dentist acting within the lawful scope of prac- tice, including a licensed endodontist. (B) Such coverage shall include, but not be limited to: (i) diagnostic examinations and evaluations; (ii) specialist consultations; (iii) radiographic and diagnostic imaging; (iv) root canal therapy; (v) endodontic retreatment procedures; (vi) apicoectomy procedures; (vii) emergency endodontic treatment; and (viii) post-treatment care reasonably related to endodontic treatment. (C) An insurer shall not deny coverage for a medically necessary covered service solely because such service is rendered by a licensed endodontist rather than a general dentist. (D) If an insurer does not maintain an adequate network of participat- ing endodontists to ensure reasonable access to covered endodontic services without unreasonable delay, the insurer shall provide coverage for services rendered by a non-participating endodontist at no greater cost-sharing obligation than would apply to services rendered by a participating provider. (E) No policy subject to this paragraph shall impose annual limita- tions, frequency limitations, or utilization review requirements for medically necessary endodontic services that are more restrictive than italics those applied to other comparable restorative dental services covered under the policy. (F) For purposes of this paragraph, "medically necessary endodontic services" means dental services necessary to diagnose, treat, relieve, or prevent infection, pain, disease, or damage affecting the dental pulp or surrounding tissues, consistent with generally accepted standards of dental practice. (24) (A) Every group policy delivered or issued for delivery in this state which provides coverage or reimbursement for dental services which includes coverage for restorative dental services shall provide coverage for medically necessary endodontic services performed by a licensed dentist acting within the lawful scope of practice, including a licensed endodontist. (B) Such coverage shall include, but not be limited to: (i) diagnostic examinations and evaluations; (ii) specialist consultations; (iii) radiographic and diagnostic imaging; (iv) root canal therapy; (v) endodontic retreatment procedures; (vi) apicoectomy procedures; (vii) emergency endodontic treatment; and (viii) post-treatment care reasonably related to endodontic treatment. (C) An insurer shall not deny coverage for a medically necessary covered service under this paragraph solely because such service is rendered by a licensed endodontist rather than a general dentist. (D) If an insurer does not maintain an adequate network of participat- ing endodontists to ensure reasonable access to covered endodontic services without unreasonable delay, the insurer shall provide coverage for services rendered by a non-participating endodontist at no greater cost-sharing obligation than would apply to services rendered by a participating provider. (E) No policy subject to this paragraph shall impose annual limita- tions, frequency limitations, or utilization review requirements for medically necessary endodontic services that are more restrictive than those applied to other comparable restorative dental services covered under the policy. (F) For purposes of this paragraph, "medically necessary endodontic services" means dental services necessary to diagnose, treat, relieve, or prevent infection, pain, disease, or damage affecting the dental pulp or surrounding tissues, consistent with generally accepted standards of dental practice. (yy) (1) Every contract issued by a medical expense indemnity corpo- ration, a hospital service corporation or a health service which includes coverage for restorative dental services shall provide coverage for medically necessa

  amended