11 CRR-NY 52.76NY-CRR
STATE COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK
TITLE 11. INSURANCE
CHAPTER III. POLICY AND CERTIFICATE PROVISIONS
SUBCHAPTER A. LIFE, ACCIDENT AND HEALTH INSURANCE
PART 52. MINIMUM STANDARDS FOR FORM, CONTENT AND SALE OF HEALTH INSURANCE, INCLUDING STANDARDS OF FULL AND FAIR DISCLOSURE
11 CRR-NY 52.76
11 CRR-NY 52.76
52.76 Coverage for preventive care and screenings.
(a)
(1) Every policy that provides hospital, surgical, or medical care coverage, except for a grandfathered health plan, shall provide coverage for preventive care and screenings for insureds pursuant to Insurance Law sections 3216(i)(17)(E), 3221(l)(8)(E) and (F), and 4303(j)(3), including coverage for pre-exposure prophylaxis with effective anti-retroviral therapy for persons who are at high risk of HIV acquisition. Such coverage shall not be subject to cost-sharing.
(2) A policy shall cover preventive care and screenings described in Insurance Law sections 3216(i)(17)(E), 3221(l)(8)(E) and (F), and 4303(j)(3) upon any policy issuance or renewal that occurs six months after the date the recommendation or guideline described in Insurance Law sections 3216(i)(17)(E), 3221(l)(8)(E) and (F), and 4303(j)(3) is issued.
(3) A policy that provides coverage for preventive care and screenings specified in any recommendation or guideline described in Insurance Law sections 3216(i)(17)(E), 3221(l)(8)(E) and (F), and 4303(j)(3) shall provide coverage through the last day of the policy year, even if the recommendation or guideline changes during the policy year.
(4) For purposes of this section, grandfathered health plan shall have the meaning set forth in Insurance Law sections 3216(i)(17)(F), 3221(l)(8)(G), and 4303(j)(4).
(b)
(1) Except as provided in paragraph (2) of this subdivision, a policy that provides hospital, surgical, or medical care coverage shall cover coronavirus disease 2019 (COVID-19) immunizations, and the administration thereof, immediately upon the earliest of the date on which:
(i) the advisory committee on immunization practices of the Federal centers for disease control issues a recommendation for the COVID-19 immunization;
(ii) the United States preventive services task force issues a recommendation with an “A” or “B” rating for the COVID-19 immunization; or
(iii) the superintendent determines, in consultation with the commissioner of health, that a policy shall cover the COVID-19 immunization. COVID-19 immunizations, and administration thereof, including any visits necessary to obtain the immunizations, administered at a provider’s office, facility, pharmacy, or other setting, including any provider or location authorized by this State or the federal government to administer or host the administration of the immunization, shall not be subject to annual deductibles, coinsurance, copayments, or any other out-of-pocket cost.
(2) The coverage required under paragraph (1) of this subdivision shall not be limited to COVID-19 immunizations, and the administration thereof, administered by participating providers and shall apply to such immunizations, and the administration thereof, administered by non-participating providers until the expiration of the federally declared public health emergency.
11 CRR-NY 52.76
Current through July 31, 2021
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