S 10607

                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
                                   10607
                             I N  S E N A T E
                               May 29, 2026
                                ___________
 Introduced  by  Sen. ADDABBO -- read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 AN ACT to amend the insurance law, in relation to insurance coverage for
   endodontic services
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
   Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
 amended by adding a new paragraph 42 to read as follows:
   (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
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD15989-01-6
 S. 10607                            2
 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.
   § 2. Subsection (l) of section 3221 of the insurance law is amended by
 adding a new paragraph 24 to read as follows:
   (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.
   §  3.  Section  4303  of  the insurance law is amended by adding a new
 subsection (yy) to read as follows:
   (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 NECESSARY ENDODONTIC  SERVICES  PERFORMED  BY  A  LICENSED
 DENTIST ACTING WITHIN THE LAWFUL SCOPE OF PRACTICE, INCLUDING A LICENSED
 ENDODONTIST.
   (2) SUCH COVERAGE SHALL INCLUDE, BUT NOT BE LIMITED TO:
   (A) DIAGNOSTIC EXAMINATIONS AND EVALUATIONS;
   (B) SPECIALIST CONSULTATIONS;
   (C) RADIOGRAPHIC AND DIAGNOSTIC IMAGING;
   (D) ROOT CANAL THERAPY;
 S. 10607                            3
   (E) ENDODONTIC RETREATMENT PROCEDURES;
   (F) APICOECTOMY PROCEDURES;
   (G) EMERGENCY ENDODONTIC TREATMENT; AND
   (H) POST-TREATMENT CARE REASONABLY RELATED TO ENDODONTIC TREATMENT.
   (3)  AN  INSURER  SHALL  NOT  DENY  COVERAGE FOR A MEDICALLY NECESSARY
 COVERED SERVICE UNDER THIS SUBSECTION SOLELY  BECAUSE  SUCH  SERVICE  IS
 RENDERED BY A LICENSED ENDODONTIST RATHER THAN A GENERAL DENTIST.
   (4) 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.
   (5)  NO  POLICY SUBJECT TO THIS SUBSECTION 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.
   (6)  FOR  PURPOSES OF THIS SUBSECTION, "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.
   § 4. The superintendent of financial services may promulgate any rules
 and regulations necessary to  implement  the  provisions  of  this  act,
 including  standards relating to network adequacy for endodontic provid-
 ers.
   § 5. This act shall take effect on the one hundred eightieth day after
 it shall have become a law and shall apply to all policies and contracts
 issued, renewed, modified, altered or amended on or after such date.