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Bill

Bill

A 7304

Prohibits private insurers from charging co-payments for an annual pediatric eye exam completed by an optometrist or ophthalmologist

2025 Regular Session Introduced by Linda Rosenthal

Prohibits private insurers from charging co-pays for annual pediatric eye exams performed by optometrists or ophthalmologists, reducing families' out-of-pocket costs.

REFERRED TO INSURANCE
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Bill Summary · A 7304

Summary of Bill A 7304

Overview

Bill A 7304 would prohibit private health insurers from requiring co-payments for annual pediatric eye exams when the examination is performed by an optometrist or an ophthalmologist. The measure aims to remove out-of-pocket costs for routine pediatric eye care provided by eye care specialists, regardless of provider type.

What the bill would do

  • Prohibit private insurers from charging co-payments for an annual pediatric eye exam.
  • Coverage would apply when the exam is completed by an optometrist or by an ophthalmologist.
  • The information provided does not specify any exemptions or carve-outs beyond “private insurers.”

Key provisions (as available)

  • Prohibition on upfront co-payments for annual pediatric eye exams conducted by optometrists or ophthalmologists.
  • Applies to private insurers; is silent on public programs (e.g., Medicaid, Medicare) based on the provided text.
  • No explicit effective date is listed in the available materials.

Affected parties

  • Private health insurers and their eye-care benefit plans.
  • Families and guardians of children who would receive annual pediatric eye exams.
  • Eye care professionals (optometrists and ophthalmologists) who perform these exams.

Legislative status and timeline

  • Introduced: March 25, 2025.
  • Status: REFERRED TO INSURANCE.
  • Legislative Actions: On March 25, 2025, the bill was referred to the Insurance committee (listed twice in the provided record, likely reflecting routine committee referral events).
  • Sponsor: Linda Rosenthal (primary).

Potential impact and considerations

  • Consumer impact: Likely reduction in out-of-pocket costs for families seeking annual pediatric eye exams, potentially improving access and adherence to routine eye care.
  • Insurer impact: Could affect plan design and cost-sharing structures for pediatric vision benefits; insurers may adjust premiums or plan features in response to the change.
  • Administrative considerations: Insurers would need to implement policy changes to remove co-pays for eligible exams and ensure consistent application across provider types (optometrist vs ophthalmologist).

Next steps

  • If advanced, the bill would move through the Insurance committee for hearings, potential amendments, and votes, before proceeding to the full chamber for consideration.
  • Further details (text of the bill, definitions, effective date, and any exemptions) would clarify the scope and implementation requirements.

Sponsor: Linda Rosenthal (primary).

Compiled from official sources — confirm details with the bill’s official record.

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