Bill > S05045

This bill amends the New York insurance law to limit the copayment or coinsurance amount that insurers can charge for physical therapy and occupational therapy services. Specifically, the bill stipulates that insurance policies cannot impose copayment or coinsurance amounts for services provided by licensed physical therapists (under article 136 of the education law) or licensed occupational therapists (under article 156 of the education law) that are more than 25% higher than the copayment or coinsurance amount charged for an office visit to a primary care physician or osteopath for the same or a similar diagnosed condition. The bill applies to various types of insurance policies, including individual health insurance, group health insurance, and health insurance for hospital and medical services. By standardizing these copayment rates, the legislation aims to make physical and occupational therapy more affordable and accessible for patients by ensuring that these specialist services are not significantly more expensive than primary care visits. The provisions will take effect on January 1, 2027, giving insurers time to adjust their policies to comply with the new requirements.

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https://www.nysenate.gov/legislation/bills/2025/S5045