senate Bill S639

Removes cancer screening deductibles, copayments and coinsurance

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 09 / Jan / 2013
    • REFERRED TO INSURANCE
  • 08 / Jan / 2014
    • REFERRED TO INSURANCE

Summary

Removes cancer screening deductibles, copayments and coinsurance.

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Bill Details

Versions:
S639
Legislative Cycle:
2013-2014
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd ยงยง3216, 3221, 4303, 4321 & 4322, Ins L
Versions Introduced in Previous Legislative Cycles:
2011-2012: S841A
2009-2010: S7064A

Sponsor Memo

BILL NUMBER:S639

TITLE OF BILL:
An act
to amend the insurance law, in relation to cancer screening deductibles
and copayments

PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this legislation is to eliminate copayments for certain
cancer screenings in order to encourage preventive care.

SUMMARY OF SPECIFIC PROVISIONS:
The following sections of law are
amended provide that mammography screening and cervical cytology
screening provided under the insurance law shall not be subject to
annual deductibles and coinsurance costs.

Section 1. subparagraph (B) of paragraph 11 and subparagraph (C) of
paragraph 15 of subsection (i) of section 3216 of the insurance law,
as amended by chapter 219 of the laws of 2011 are amended.

Section 2. Subparagraph (B) of paragraph 11 and subparagraph (C) of
paragraph 14 of subsection (1) of section 3221 of the insurance law,
as amended by chapter 219 of the laws of 2011, are amended.

Section 3. Subparagraph (D) of paragraph 1 of subsection (p) and
paragraph 1 of subsection (t) of section 4303 of the insurance law,
as amended by chapter 219 of the laws of 2011, are amended,

Section 4. Subsection (c) of section 4321 of the insurance law, as
amended by chapter 219 of the laws of 2011, are amended.

Section 5. Subsections (c) and (d) of section 4322 of the insurance
law, as amended by chapter 219 of the laws of 2011, are amended"

JUSTIFICATION:
It is well established that our country and state must transition to a
more prevention-based health care system. In addition to being
considerably more cost effective than our current treatment regime,
preventive care will save lives and improve health outcomes by
encouraging the early detection and treatment of illness.

This legislation would accomplish one objective within this broader
effort by eliminating required insurance co-payments for most
varieties of cancer screenings, with the exception of tests whose
radiation levels require a more restrictive testing regimen. Although
modest in price compared to costs borne by the uninsured, these
copayments act as a disincentive and their elimination would increase
the number of people who receive cancer testing. A New England Journal
of Medicine study found that a $10 copayment reduced the percentage
of women screened for breast cancer from 78% to 69% compared to an
equivalent group eligible for free testing.

PRIOR LEGISLATIVE HISTORY:
Previously introduced.


FISCAL IMPLICATIONS:
None to the state.

EFFECTIVE DATE:
This act shall take effect immediately and the
provisions of this act shall apply to policies and contracts issued,
renewed, modified or altered on or after such effective date

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                   639

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by Sen. STAVISKY -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

AN ACT to amend the insurance  law,  in  relation  to  cancer  screening
  deductibles and copayments

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subparagraph (B) of paragraph 11 and  subparagraph  (C)  of
paragraph  15 of subsection (i) of section 3216 of the insurance law, as
amended by chapter 219 of the laws of  2011,  are  amended  to  read  as
follows:
  (B) Such coverage required pursuant to subparagraph (A) or (C) of this
paragraph  [may]  SHALL NOT be subject to annual deductibles and coinsu-
rance [as may be deemed appropriate by the  superintendent  and  as  are
consistent  with  those  established  for  other benefits within a given
policy].
  (C) Such coverage required pursuant to subparagraph (A) or (B) of this
paragraph [may] SHALL NOT be subject to annual deductibles  and  coinsu-
rance  [as  may  be  deemed appropriate by the superintendent and as are
consistent with those established for  other  benefits  within  a  given
policy].
  S  2.   Subparagraph (B) of paragraph 11 and subparagraph (C) of para-
graph 14 of subsection (1) of section 3221  of  the  insurance  law,  as
amended  by  chapter  219  of  the  laws of 2011, are amended to read as
follows:
  (B) Such coverage required pursuant to subparagraph (A) or (C) of this
paragraph [may] SHALL NOT be subject to annual deductibles  and  coinsu-
rance  [as  may  be  deemed appropriate by the superintendent and as are
consistent with those established for  other  benefits  within  a  given
policy].

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03550-01-3

S. 639                              2

  (C) Such coverage required pursuant to subparagraph (A) or (B) of this
paragraph  [may]  SHALL NOT be subject to annual deductibles and coinsu-
rance [as may be deemed appropriate by the  superintendent  and  as  are
consistent  with  those  established  for  other benefits within a given
policy].
  S 3. Subparagraph (D) of paragraph 1 of subsection (p) and paragraph 1
of  subsection  (t)  of section 4303 of the insurance law, as amended by
chapter 219 of the laws of 2011, are amended to read as follows:
  (D) The coverage required in this paragraph or paragraph two  of  this
subsection  [may] SHALL NOT be subject to annual deductibles and coinsu-
rance [as may be deemed appropriate by the  superintendent  and  as  are
consistent  with  those  established  for  other benefits within a given
contract].
  (1) A medical expense indemnity corporation, a hospital service corpo-
ration or a health service corporation that provides coverage for hospi-
tal, surgical, or medical care shall  provide  coverage  for  an  annual
cervical cytology screening for cervical cancer and its precursor states
for  women aged eighteen and older. Such coverage required by this para-
graph [may] SHALL NOT be subject to annual deductibles  and  coinsurance
[as  may be deemed appropriate by the superintendent and as are consist-
ent with those established for other benefits within a given contract].
  S 4. Subsection (c) of section 4321 of the insurance law,  as  amended
by chapter 219 of the laws of 2011, is amended to read as follows:
  (c)  The health maintenance organization shall impose a fifteen dollar
copayment on all visits to a physician or other provider with the excep-
tion of visits for pre-natal and  post-natal  care,  well  child  visits
provided  pursuant  to  paragraph  two  of  subsection  (j), MAMMOGRAPHY
SCREENING PROVIDED PURSUANT TO SUBSECTION  (P),  AND  CERVICAL  CYTOLOGY
SCREENING  PROVIDED  PURSUANT TO SUBSECTION (T) of section four thousand
three hundred three of this article, preventive health services provided
pursuant to subparagraph (F) of paragraph  four  of  subsection  (b)  of
section four thousand three hundred twenty-two of this article, or items
or  services  for bone mineral density provided pursuant to subparagraph
(D) of paragraph twenty-six of subsection (b) of section  four  thousand
three  hundred  twenty-two  of this article for which no copayment shall
apply. A copayment of fifteen dollars shall  be  imposed  on  equipment,
supplies  and self-management education for the treatment of diabetes. A
fifty dollar copayment shall be imposed on emergency  services  rendered
in  the  emergency  room  of a hospital; however, this copayment must be
waived if hospital admission results. Surgical services shall be subject
to a copayment of the lesser of twenty  percent  of  the  cost  of  such
services  or  two  hundred dollars per occurrence. A five hundred dollar
copayment shall be imposed on inpatient hospital services per continuous
hospital confinement. Ambulatory surgical services shall be subject to a
facility copayment charge of seventy-five dollars.  Coinsurance  of  ten
percent shall apply to visits for the diagnosis and treatment of mental,
nervous or emotional disorders or ailments.
  S  5. Subsections (c) and (d) of section 4322 of the insurance law, as
amended by chapter 219 of the laws of  2011,  are  amended  to  read  as
follows:
  (c)  The in-plan benefit system shall impose a ten dollar copayment on
all visits to a physician or other provider with the exception of visits
for pre-natal and post-natal care, well child visits  provided  pursuant
to  paragraph  two  of  subsection  (j),  MAMMOGRAPHY SCREENING PROVIDED
PURSUANT TO SUBSECTION (P), AND  CERVICAL  CYTOLOGY  SCREENING  PROVIDED
PURSUANT  TO SUBSECTION (T) of section four thousand three hundred three

S. 639                              3

of this article, preventive health services provided pursuant to subpar-
agraph (F) of paragraph four of subsection (b) of this section or  items
or  services  for bone mineral density provided pursuant to subparagraph
(D)  of paragraph twenty-six of subsection (b) of this section for which
no copayment shall apply. A copayment of ten dollars shall be imposed on
equipment, supplies and self-management education for the  treatment  of
diabetes. Coinsurance of ten percent shall apply to visits for the diag-
nosis  and  treatment  of  mental,  nervous  or  emotional  disorders or
ailments. A thirty-five dollar copayment shall be imposed  on  emergency
services  rendered  in  the  emergency room of a hospital; however, this
copayment must be waived if hospital admission results.
  (d) The out-of-plan benefit system shall  have  an  annual  deductible
established  at one thousand dollars per calendar year for an individual
and two thousand dollars per year for a  family.  Coinsurance  shall  be
established  at  twenty percent with the health maintenance organization
or insurer paying eighty percent of the usual, customary and  reasonable
charges, or eighty percent of the amounts listed on a fee schedule filed
with  and  approved  by  the  superintendent which provides a comparable
level of reimbursement. Coinsurance of ten percent shall apply to outpa-
tient visits for the diagnosis  and  treatment  of  mental,  nervous  or
emotional  disorders or ailments. The benefits described in subparagraph
(F) of paragraph three, SUBPARAGRAPHS (D) AND (E) OF PARAGRAPH FOUR  and
paragraphs  seventeen  and  eighteen  of  subsection (b) of this section
shall not be subject to the  deductible  or  coinsurance.  The  benefits
described  in paragraph nine of subsection (b) of this section shall not
be subject to the  deductible.  The  out-of-plan  out-of-pocket  maximum
deductible  and  coinsurance  shall  be  established  at  three thousand
dollars per calendar year for an individual and  five  thousand  dollars
per calendar year for a family. The out-of-plan lifetime benefit maximum
shall  be established at five hundred thousand dollars for benefits that
are not essential health benefits. A lifetime limit on the dollar amount
of essential health benefits for any  individual  shall  not  be  estab-
lished.  For  purposes  of  this subsection, "essential health benefits"
shall have the meaning ascribed by section  1302(b)  of  the  Affordable
Care Act, 42 U.S.C. S 18022(b).
  S 6. This act shall take effect immediately and the provisions of this
act  shall  apply  to  policies and contracts issued, renewed, modified,
altered or amended on or after such effective date.

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