Bill > S00965

This bill requires health insurance providers in New York to offer coverage for patients seeking treatment from specialized providers for certain complex medical conditions, including rare diseases, life-threatening conditions, degenerative and disabling conditions, and diagnoses involving medically fragile children. To qualify for this out-of-network coverage, the chosen provider must meet specific criteria: their costs must be comparable to in-network providers, the patient's primary care physician must recommend the provider, and the provider must have specialized expertise in treating the specific medical condition, as verified by health departments or national health organizations. The bill defines key terms such as "rare disease" and "medically fragile child" by referencing existing public health law definitions, and ensures that while insurers must provide this coverage, they are not required to cover travel expenses to see the chosen provider. The legislation applies to various types of health insurance policies, including hospital, surgical, medical, and major medical coverage, and will take effect 90 days after becoming law, applying to all insurance policies issued, renewed, or modified after that date.

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https://www.nysenate.gov/legislation/bills/2025/S965