NY A11340

Establishes a state-level essential health benefits package to provide health insurance protection in New York if the federal Affordable Care Act is repealed, requiring insurers and health service corporations to offer coverage with at least ten specified benefit categories including ambulatory services, emergency care, hospitalization, maternity care, mental health services, prescription drugs, rehabilitation services, laboratory services, preventive care, and pediatric services.

Mandates four levels of coverage (bronze at 60%, silver at 70%, gold at 80%, and platinum at 90% actuarial value) and establishes annual limitations on cost-sharing requirements that adjust annually based on premium growth rates.

Grants the superintendent of financial services authority to define essential health benefits, prohibits discrimination in coverage based on age or disability, requires equal cost-sharing for emergency services regardless of provider network status, and allows periodic updates to address coverage gaps.

Amends existing insurance law provisions to replace references to the federal Affordable Care Act with references to the new state essential health benefits requirements in sections covering small group policies, student health insurance, medical expense corporations, and health service corporations.

Takes effect only upon full repeal of the federal Affordable Care Act, with the superintendent required to notify the legislative bill drafting commission when repeal occurs.