BILL NUMBER: S9230
SPONSOR: SCARCELLA-SPANTON
 
TITLE OF BILL:
An act to amend the insurance law, in relation to coverage for perimeno-
pausal and menopausal care and treatment
 
PURPOSE OR GENERAL IDEA OF BILL:
This bill requires all applicable health insurance policies in New York
State to provide coverage for medically necessary perimenopausal and
menopausal care. It ensures that individuals experiencing menopausal or
perimenopausal symptoms receive standardized, comprehensive, and afford-
able access to treatment from licensed health care providers.
 
SUMMARY OF PROVISIONS:
Section 1 amends § 3216(i) of the Insurance Law by adding paragraph 40,
mandating coverage for perimenopausal and menopausal care under individ-
ual accident and health insurance policies. Coverage must include treat-
ment for symptoms such as irregular menstruation, hot flashes, chills,
slowed metabolism, bladder or vaginal issues, decreased fertility, bone
loss, increased LDL cholesterol, and sleep disruption. Definitions of
"menopause" and "perimenopause" are added for clarity. Coverage may be
subject to standard deductibles and coinsurance.
Section 2 amends § 3221(k) by adding paragraph 24, applying identical
coverage mandates to group accident and health insurance policies.
Section 3 amends § 4303 by adding subsection (ww), extending the same
coverage requirements to contracts issued by medical expense indemnity
corporations, hospital service corporations, and health service corpo-
rations.
Section 4 sets the effective date as the January 1 following enactment
and applies the requirements to all policies issued, renewed, reissued,
modified, or amended on or after that date.
 
JUSTIFICATION:
Perimenopause and menopause are major physiological transitions that
affect millions of New Yorkers yet care for these conditions is incon-
sistently covered across insurance plans. Many individuals report
untreated symptoms that profoundly impact their physical health,
emotional well-being, work productivity; and daily functioning.
Despite the prevalence of symptoms such as hot flashes, menstrual irreg-
ularities, bone loss, metabolic changes, and sleep disturbances, insur-
ance carriers often deny or limit coverage for treatments, leaving
patients to pay out-of-pocket or forgo care entirely. This dispropor-
tionately harms low-income individuals, women of color, and those lack-
ing access to specialized health providers.
By standardizing coverage across insurance types, this bill closes gaps
in reproductive and hormonal health care. It establishes clear defi-
nitions of menopause and perimenopause, specifies covered symptoms, and
ensures that licensed medical professionals can provide evidence-based
treatment without unnecessary barriers.
This legislation moves New York toward more equitable health care access
and affirms that menopausal health is an essential component of compre-
hensive medical care.
 
LEGISLATIVE HISTORY:
New bill.
 
FISCAL IMPLICATIONS:
Minimal. Insurance carriers may experience slight utilization increases,
but costs are expected to be offset by reduced long-term expenditures
associated with untreated menopausal symptoms (e.g., osteoporosis,
cardiovascular risk, sleep-related health issues)
 
EFFECTIVE DATE:
This act shall take effect on January 1

Statutes affected:
S9230: 3216 insurance law, 3216(i) insurance law, 3221 insurance law, 3221(k) insurance law, 4303 insurance law