N.Y. Comp. Codes R. & Regs. tit. 11 § 52.76

Current through Register Vol. 46, No. 45, November 2, 2024

Section 52.76 - Coverage for preventive care and screenings

(a)

(1) Every policy that provides hospital, surgical, or medical care coverage, except for a grandfathered health plan, shall provide coverage for preventive care and screenings for insureds pursuant to Insurance Law sections 3216(i)(17)(E), 3221(l)(8)(E) and (F), and 4303(j)(3), including coverage for preexposure prophylaxis with effective antiretroviral therapy to persons who are at high risk of HIV acquisition. Such coverage shall not be subject to cost-sharing.

(2) A policy shall cover preventive care and screenings described in Insurance Law sections 3216(i)(17)(E), 3221(l)(8)(E) and (F), and 4303(j)(3) upon any policy issuance or renewal that occurs six months af- ter the date the recommendation or guideline described in Insurance Law sections 3216(i)(17)(E), 3221(l)(8)(E) and (F), and 4303(j)(3) is issued.

(3) A policy that provides coverage for preventive care and screenings specified in any recommendation or guideline described in Insurance Law sections 3216(i)(17)(E), 3221(l)(8)(E) and (F), and 4303(j)(3) shall provide coverage through the last day of the policy year, even if the recommendation or guideline changes during the policy year.

(4) For purposes of this section, "grandfathered health plan" shall have the meaning set forth in Insurance Law sections 3216(i)(17)(F), 3221(l)(8)(G), and 4303(j)(4).

N.Y. Comp. Codes R. & Regs. Tit. 11 § 52.76

Adopted New York State Register April 29, 2020/Volume XLII, Issue 17, eff. 7/28/2020