Senate Bill S7064A

2009-2010 Legislative Session

Removes cancer screening deductibles, copayments and coinsurance

download bill text pdf

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 23, 2010	print number 7064a
Jun 23, 2010	amend and recommit to insurance
Mar 10, 2010	referred to insurance

Bill Amendments

2009-S7064 - Details

See Assembly Version of this Bill:: A10106
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221, 4303, 4321 & 4322, Ins L
Versions Introduced in Other Legislative Sessions:: 2011-2012: S841, A4378
2013-2014: S639

2009-S7064 - Summary

Removes cancer screening deductibles, copayments and coinsurance.

2009-S7064 - Sponsor Memo

                                 BILL NUMBER:  S7064

 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 bill would amend:
Insurance law Section 3216, subsection( i), subparagraph (B) paragraph
B of paragraph 11 and subparagraph (C) of paragraph15, Insurance Law
section 3221, section 1, subparagraph (B) of paragraph 11 and
subparagraph (C) of paragraph 14 and Insurance Law section 4304,
subsection (t), paragraph 1 and subsection (p) paragraph 1, to state
that such coverage shall not be subject to annual deductibles and
coinsurance, as may be deemed appropriate by the superintendent and as
is consistent with those established for other benefits within a given
policy.

Insurance Law section 4321 subsection (c) and Insurance Law section
4322 subsections (c) and (d) to add an exception for visits for
mammography screening and cervical cytology screening pursuant to the

amendments above.

 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 :
New bill.

 FISCAL IMPLICATIONS :
None.

 EFFECTIVE DATE :
This act shall take effect on the first of January next succeeding the
date on which it shall become a law and the provisions of this act
shall apply to policies and contracts issued, renewed, altered on or
after such effective date.

2009-S7064 - Bill Text download pdf

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

                                  7064

                            I N  S E N A T E

                             March 10, 2010
                               ___________

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,
subparagraph (B) as added by chapter 417 of the laws of 1989 and subpar-
agraph (C) as amended by chapter 43 of the laws of 1993, are amended  to
read as follows:
  (B) Such coverage [may] SHALL NOT be subject to annual deductibles and
coinsurance  [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 [may] SHALL NOT be subject to annual deductibles and
coinsurance  [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  554  of  the  laws of 2002, are amended to read as
follows:
  (B) Such coverage [may] SHALL NOT be subject to annual deductibles and
coinsurance [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 [may] SHALL NOT be subject to annual deductibles and
coinsurance [as may be deemed appropriate by the superintendent  and  as
are  consistent with those established for other benefits within a given
policy].
  S 3. The closing paragraph of paragraph 1 of subsection (p) and  para-
graph  1  of  subsection  (t)  of  section 4303 of the insurance law, as

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD16171-01-0

S. 7064                             2

amended by chapter 554 of the laws of  2002,  are  amended  to  read  as
follows:
  The coverage required in this paragraph [may] SHALL NOT  be subject to
annual  deductibles and coinsurance [as may be deemed appropriate by the
superintendent and as are consistent with those  established  for  other
benefits within a given policy].
  (1) A medical expense indemnity corporation, a hospital service corpo-
ration  or  a  health  service  corporation  which provides coverage for
hospital, 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 [may]  SHALL  NOT  be
subject  to  annual deductibles and coinsurance [as may be deemed appro-
priate by the superintendent and as are  consistent  with  those  estab-
lished for other benefits within a given contract].
  S  4. Subsection (c) of section 4321 of the insurance law, as added by
chapter 504 of the laws of 1995, 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 or 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 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
added by chapter 504 of the  laws  of  1995,  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 or 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 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 diagnosis 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

S. 7064                             3

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.
  S 6. This act shall take effect on the first of January next  succeed-
ing  the  date on which it shall have become a law and the provisions of
this act shall apply to policies and contracts  issued,  renewed,  modi-
fied, altered or amended on or after such effective date.

2009-S7064A (ACTIVE) - Details

See Assembly Version of this Bill:: A10106
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221, 4303, 4321 & 4322, Ins L
Versions Introduced in Other Legislative Sessions:: 2011-2012: S841, A4378
2013-2014: S639

2009-S7064A (ACTIVE) - Summary

Removes cancer screening deductibles, copayments and coinsurance.

2009-S7064A (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S7064A

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 bill would amend:
Insurance law Section 3216, subsection(i), subparagraph (B)
paragraph B of paragraph 11 and subparagraph (e) of paragraph 15,
Insurance Law section 3221, section 1, subparagraph (B) of paragraph
11 and subparagraph (e) of paragraph 14 and Insurance Law section
4304, subsection (t), paragraph 1 and subsection (p) paragraph 1, to
state that such coverage shall not be subject to annual deductibles
and coinsurance, as may be deemed appropriate by the superintendent
and as is consistent with those established for other benefits within
a given policy.

Insurance Law section 4321 subsection (c) and Insurance Law section
4322 subsections (c) and (d) to add an exception for visits for
mammography screening and cervical cytology screening pursuant to the

amendments above.

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:
New bill.

FISCAL IMPLICATIONS:
None.

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

2009-S7064A (ACTIVE) - Bill Text download pdf

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

                                 7064--A

                            I N  S E N A T E

                             March 10, 2010
                               ___________

Introduced  by Sen. STAVISKY -- read twice and ordered printed, and when
  printed to be committed to the Committee  on  Insurance  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

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,
subparagraph (B) as added by chapter 417 of the laws of 1989 and subpar-
agraph  (C) as amended by chapter 43 of the laws of 1993, are amended to
read as follows:
  (B) Such coverage [may] SHALL NOT be subject to annual deductibles and
coinsurance [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 [may] SHALL NOT be subject to annual deductibles and
coinsurance [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 554 of the laws of  2002,  are  amended  to  read  as
follows:
  (B) Such coverage [may] SHALL NOT be subject to annual deductibles and
coinsurance  [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 [may] SHALL NOT be subject to annual deductibles and
coinsurance  [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.
                                                           LBD16171-03-0

S. 7064--A                          2

  S  3. The closing paragraph of paragraph 1 of subsection (p) and para-
graph 1 of subsection (t) of section  4303  of  the  insurance  law,  as
amended  by  chapter  554  of  the  laws of 2002, are amended to read as
follows:
  The coverage required in this paragraph [may] SHALL NOT  be subject to
annual  deductibles and coinsurance [as may be deemed appropriate by the
superintendent and as are consistent with those  established  for  other
benefits within a given policy].
  (1) A medical expense indemnity corporation, a hospital service corpo-
ration  or  a  health  service  corporation  which provides coverage for
hospital, 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 [may]  SHALL  NOT  be
subject  to  annual deductibles and coinsurance [as may be deemed appro-
priate by the superintendent and as are  consistent  with  those  estab-
lished for other benefits within a given contract].
  S  4. Subsection (c) of section 4321 of the insurance law, as added by
chapter 504 of the laws of 1995, 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 or 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 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
added by chapter 504 of the  laws  of  1995,  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 or 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 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 diagnosis 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

S. 7064--A                          3

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.
  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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Senate Bill S7064A

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

Actions

Bill Amendments

2009-S7064 - Details

2009-S7064 - Summary

2009-S7064 - Sponsor Memo

2009-S7064 - Bill Text download pdf

2009-S7064A (ACTIVE) - Details

2009-S7064A (ACTIVE) - Summary

2009-S7064A (ACTIVE) - Sponsor Memo

2009-S7064A (ACTIVE) - Bill Text download pdf

Comments

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Sponsored By

Toby Ann Stavisky

Archive: Last Bill Status - In Senate Committee Insurance Committee

Actions

Bill Amendments

2009-S7064 - Details

2009-S7064 - Summary

2009-S7064 - Sponsor Memo

2009-S7064 - Bill Text download pdf

2009-S7064A (ACTIVE) - Details

2009-S7064A (ACTIVE) - Summary

2009-S7064A (ACTIVE) - Sponsor Memo

2009-S7064A (ACTIVE) - Bill Text download pdf

Comments