New York State Seal
STATE OF NEW YORK
INSURANCE DEPARTMENT
25 BEAVER STREET
NEW YORK, NEW YORK 10004

The Office of General Counsel issued the following informal opinion on February 19, 2002, representing the position of the New York State Insurance Department.

RE: Health Insurance Coverage of Domestic Partners

Question Presented:

Are dental and vision coverages encompassed within those coverages that may be provided to domestic partners of individuals insured under group health insurance policies and contracts?

Conclusion:

Such coverages are encompassed within those that may be provided to domestic partners.

Facts:

By letter of August 24, 2001, pursuant to New York Insurance Law §§ 4325(f)(1) (McKinney 2000) and 4305(c)(1) (McKinney 2000), the Department concluded that an insurer may, but need not, cover domestic partners of individuals insured under group health insurance policies covering "medical, dental or vision care." An inquiry was made as to whether, because of the language of the Insurance Law, the ability to afford coverage to domestic partners is limited to policies covering medical care, which term does not encompass dental or vision care.

Analysis:

New York Insurance Law §4235(f)(1), which regulates group accident & health insurance policies issued by commercial insurers, provides with respect to such policies:

Any policy of group accident, group health or group accident and health insurance may include provisions for the payment by the insurer of benefits for expenses incurred on account of hospital, medical or surgical care … for the employee … his spouse, his child or children, or other persons chiefly dependent upon him for support and maintenance . . . . (emphasis added)

New York Insurance Law §4305(c)(1), which regulates group contracts issued by not-for-profit health insurers and Health Maintenance Organizations has a similar provision.

The practice of medicine is defined, New York Education Law § 6521 (McKinney 2001):

the practice of the profession of medicine is defined as diagnosing, treating, operating or prescribing for any human disease, pain, injury, deformity or physical condition.

The practice of dentistry is defined, New York Education Law § 6601 (McKinney 2001):

The practice of the profession of dentistry is defined as diagnosing, treating, operating, or prescribing for any disease, pain, injury, deficiency, deformity, or physical condition of the human mouth, including the teeth, alveolar process, gums, or jaws, and adjacent tissues . . . . The practice of dentistry may include performing physical evaluations in conjunction with the provision of dental treatment.

The practice of optometry is defined, New York Education Law § 7101 (McKinney 2001):

The practice of the profession of optometry is defined as diagnosing and treating optical deficiency, optical deformity, visual anomaly, muscular anomaly or disease of the human eye and adjacent tissue by prescribing, providing, adapting or fitting lenses, or by prescribing or providing orthoptics or vision training, or by prescribing and using drugs. The practice of optometry shall not include any injection or invasive modality . . . . The use of drugs by optometrists is authorized only in accordance with the provisions of this article and regulations promulgated by the commissioner.

As can be seen from the above definitions, the practice of medicine encompasses within it those activities that are within the scope of practice of a dentist or optometrist. In addition, there is a medical specialty, ophthalmology, which provides many of the same services as are provided by optometrists.

In defining "medical care", in the context of domestic relations actions, courts have been expansive and have included services provided by health professionals other than physicians, e.g. Noble v. Noble, 99 Misc. 2d 498, 416 N.Y.S. 2d 510 (Family Ct. Rensselaer 1979).

The underlined language in New York Insurance Law § 4235(f)(1) was included to distinguish the specified services, which are part of the definition of accident & health insurance in New York Insurance Law § 1113(a)(3)(i) (McKinney 2000), from policies covering indemnification of the insured because of disability, which is that part of the definition of accident & health insurance found in New York Insurance Law § 1113(a)(3)(ii), and was not intended to exclude either dental or vision care.

Accordingly, this Department finds no reason to modify the conclusion expressed in the August 24, 2001 letter.

For further information you may contact Principal Attorney Alan Rachlin at the New York City Office.