BILL NUMBER: S8326
SPONSOR: SKOUFIS
 
TITLE OF BILL:
An act to amend the insurance law, in relation to requiring health
insurance contracts provide coverage to developmentally disabled persons
beyond twenty-six years of age
 
PURPOSE:
The purpose of this bill is to expand insurance coverage for develop-
mentally disabled individuals by ensuring that they continue receiving
health insurance benefits beyond the current age limit of twenty-six.
This bill recognizes that many developmentally disabled individuals are
unable to secure self-sustaining employment due to their condition,
necessitating continued coverage under a parent's or guardian's health
insurance plan.
 
SUMMARY OF PROVISIONS:
Section 1: Amends subparagraph c of paragraph of subsection (a) of
section 3216 of the insurance law to extend coverage under a
policyholder's insurance plan to unmarried dependent children with
developmental disabilities, mental illness, or physical disabilities,
who become incapable of self-sustenance employment before the termi-
nation of dependent coverage. Coverage will continue indefinitely past
the age of twenty-six.
Section 2: Amends subsparagh (b) of paragraph 5 or subsection c of
section 3216 of the insurance law, establishes mandatory notification
requirements for insurers. Under this provision, insurance providers
must send written notice to policyholders at least six months. Through
this provision, insurance providers must send written notice to policy-
holders at least six months. This notice must clearly outline the option
for continued coverage under this bill for qualifying dependents,
explain the process for submitting proof of incapacity, and provide a
deadline by which the required proof must be submitted to prevent cover-
age termination.
Section 3: Amends the insurance law by adding a new section 3246 to
Section 3246 to prohibit insurance providers from terminating coverage
for an unmarried dependent child who meets the disability criteria
outlined in Section 1, and would otherwise lose coverage solely due to
reaching the age of twenty-six. Additionally, the amendment grants the
superintendent the authority to impose civil penalties if the insurer
knowingly and willfully violates the provisions in this section. The
penalty can be more than ten. thousand dollars for each violation.
Section 4: Amends the insurance law by adding a new section 3247 under
which insurers are required to request recertification of a dependent's
condition no more than once every five years, unless there is a substan-
tial change in the dependent's medical status.
Section 5: Amends paragraph 3 of subsection (d) of Section 4304 of the
Insurance Law. Under this provision, coverage shall not be terminated if
the dependent child becomes incapacitated before reaching the age at
which dependent coverage would otherwise cease and remains chiefly
dependent on the contract holder for support and maintenance. To ensure
policyholders are aware of the continuation of coverage option, the law
requires insurers to provide contract holders with at least six months'
advance written notice before coverage is set to terminate. If the
contract holder provides the necessary documentation within thirty-one
days of the child reaching the limiting age, coverage shall remain in
force without interruption.
Section 6: Amends item (ii) of subparagraph (a) of paragraph 1 of
subsection (c) of section 4305 of the insurance law to state that poli-
cyholders are adequately informed about their rights under this bill;
this section mandates that insurers provide written notice at least six
months before a dependent's scheduled termination of coverage.
Section 7: Amends the insurance law by adding a new section 4331 to
mandate that any corporation offering group health insurance must comply
with the law's requirements and extend dependent coverage for unmarried
individuals with qualifying disabilities. Just as with individual poli-
cies, group insurers are prohibited from terminating coverage solely
based on age, employment, or marital status. Additionally, penalties
outlined in Section 4 apply to group insurance providers that wrongfully
deny coverage. Additionally, the amendment grants the superintendent the
authority to impose civil penalties if the insurer knowingly and will-
fully violates the provisions in this section. The penalty can be more
than ten thousand dollars for each violation.
Section 8: Amends the insurance law by adding a new section 4332 to
ensure that insurance providers adhere to fair and reasonable recertif-
ication practices. Insurers may only require recertification of a depen-
dent's condition once every five years unless there is a significant and
documented change in the dependent's medical status.
Section 9: Sets effective date.
 
JUSTIFICATION:
Many developmentally disabled individuals require long-term support and
care. However, current insurance laws generally limit dependent coverage
to age twenty-six, failing to recognize the unique needs of these indi-
viduals. Without continued health insurance coverage, these individuals
face significant financial and medical hardships, which can increase the
burden on state-funded programs.
This bill ensures that developmentally disabled individuals who are
unable to maintain self-sustaining employment can remain covered under
their parents' or guardians' insurance policies beyond age twenty-six.
By extending coverage indefinitely for those who qualify, this legis-
lation promotes financial stability for families while safeguarding the
health and well-being of these vulnerable individuals.
 
LEGISLATIVE HISTORY:
New Bill.
 
FISCAL IMPLICATIONS:
None.
 
EFFECTIVE DATE:
This act shall take effect January 1, 2026, and shall apply to policies
and contracts issued, renewed, modified, altered, or amended on or after
such date.