S.5192 (Seward)


S.5192 (Seward)


Clarifies ACA “excepted benefit” status of certain student insurance coverages



The Business Council supports S.5192, which clarifies that student dental, vision, and intercollegiate sports injury coverages, are in fact, permitted by the ACA, and thus authorized under New York law as “excepted benefits” to institutions of higher education.

Current statute makes no distinction between traditional student accident and health insurance policies and policies of excepted benefits (such as dental, vision, accident or supplemental insurance policies). While under existing law and regulation, the exclusion of interscholastic sports injuries in blanket policies is allowed, the Department of Financial Services (DFS) has questioned the permissibility of these exclusions, thus giving rise to the need for statutory clarification.

DFS has narrowly interpreted the law to require all policies issued to students of institutions of higher education to include comprehensive essential health benefits without annual or life-time dollar limitations, making it very difficult for colleges to offer their students dental coverage, vision coverage, and intercollegiate sports injury coverage recognized by the ACA as "excepted benefits,” while these coverages remain available to students in other states.

DFS has also interpreted the law as prohibiting insurers from issuing sports accident policies covering the first $90,000 of a student athlete's expenses as required by the NCAA, which unnecessarily places New York's colleges and universities at a major financial disadvantage to their out-of-state counterparts.

The Business Council, on behalf of its many member colleges and universities, believes that these insurance policies are critical to the financial well-being of our institutions of higher learning and their students and those policies should be allowed to continue without unnecessary administrative interruption.   For these reasons, The Business Council urges passage of S.5192. .