New York Senate Bill S05313

New York 2025-2026 Regular Session

• Introduced: 2/20/25
• Refer: 2/20/25
• Refer: 1/7/26

Caption

Addresses non-covered dental services by requiring all policies providing coverage of and all contracts for dental services issued to include a disclosure stating that a participating provider may charge their normal fee for services that are not covered; requires a cost estimate to be provided.

Summary

This bill amends the New York Insurance Law to require certain health and dental insurance policies and contracts that include dental coverage to disclose, in plain language, that if an enrollee chooses services that are not covered under the plan, a participating provider may charge its normal fee for those services. The required notice also must state that, before providing non-covered services, the provider must give an estimated cost for each service. The bill defines “covered services” broadly to include dental services eligible for reimbursement under the plan, including services that would otherwise be reimbursable but for plan limits such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limits, alternative benefit payments, or similar restrictions. It applies the disclosure requirement to policies issued under Insurance Law sections 3216 and 3221, and to certain contracts issued by medical expense indemnity corporations, dental expense indemnity corporations, and health service corporations under section 4303.

Impact

The bill would add a new consumer disclosure requirement to New York insurance contracts and policies that cover dental services, affecting insurers, dental plans, and participating providers. It does not change benefit mandates or expand coverage, but it would require standardized notice language and pre-service cost estimates for non-covered dental services in applicable policies and contracts issued on or after January 1, 2027.

Sentiment

The available legislative record suggests generally favorable treatment of the bill. It was introduced by a bipartisan group of senators, reported favorably from the Senate Insurance Committee, and advanced through multiple readings with amendment and reprinting. No committee transcript or recorded vote opposition is provided in the materials, so the overall sentiment appears supportive and focused on consumer transparency.

Contention

The main policy issue is consumer disclosure versus provider billing flexibility. The bill preserves a participating provider’s ability to charge its normal fee for services that are outside the plan’s coverage, while requiring advance notice and an estimated cost. Any contention would likely center on whether the disclosure is sufficient to protect patients from unexpected dental bills, and whether the requirement imposes administrative burdens on insurers and dental providers. The materials provided do not show specific opposition or debate from named stakeholders.