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

                                  7407

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                              April 6, 2009
                               ___________

Introduced  by  M.  of  A.  CYMBROWITZ, MAISEL, PHEFFER, COLTON, BARRON,
  BRADLEY,  CASTRO,   FIELDS,   GABRYSZAK,   GALEF,   GREENE,   GUNTHER,
  HYER-SPENCER,  JAFFEE,  REILLY, ROBINSON, STIRPE, TITONE, ZEBROWSKI --
  Multi-Sponsored by -- M. of A. GLICK, GOTTFRIED, McENENY, MENG,  SWEE-
  NEY,  WEINSTEIN, WEISENBERG -- read once and referred to the Committee
  on Insurance

AN ACT to amend the insurance law, in relation  to  providing  insurance
  coverage for colorectal cancer early detection

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

  Section 1. Subsection (l) of section 3221  of  the  insurance  law  is
amended by adding a new paragraph 12-a to read as follows:
  (12-A)(A)  EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
WHICH PROVIDES MEDICAL COVERAGE THAT  INCLUDES  COVERAGE  FOR  PHYSICIAN
SERVICES  IN  A PHYSICIAN'S OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR
MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE,  UPON  THE
PRESCRIPTION  OF  A HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE
UNDER TITLE EIGHT OF THE EDUCATION LAW, THE FOLLOWING COVERAGE FOR DIAG-
NOSTIC SCREENING FOR COLORECTAL CANCER:
  (I) STANDARD DIAGNOSTIC TESTING INCLUDING, BUT NOT LIMITED TO, A COLO-
NOSCOPY AND THE  MOST  RELIABLE,  MEDICALLY  RECOGNIZED  SCREENING  TEST
AVAILABLE AT ANY AGE FOR ANY PERSON HAVING A PRIOR HISTORY OF COLORECTAL
CANCER;
  (II)  AN  ANNUAL  STANDARD  DIAGNOSTIC  EXAMINATION INCLUDING, BUT NOT
LIMITED TO, A COLONOSCOPY AND THE  MOST  RELIABLE  MEDICALLY  RECOGNIZED
SCREENING TEST AVAILABLE FOR ANY PERSON AGE FIFTY AND OVER WHO IS ASYMP-
TOMATIC  AND  FOR ANY PERSON AGE FORTY AND OVER WITH A FAMILY HISTORY OF
COLORECTAL CANCER OR OTHER COLORECTAL CANCER RISK FACTORS; AND
  (III) ANY ANCILLARY SERVICE SUCH AS BUT NOT LIMITED TO  PATHOLOGY  AND
ANESTHESIOLOGY  THAT  THE  POLICYHOLDER'S  PHYSICIAN  DETERMINES  TO  BE
MEDICALLY NECESSARY AND APPROPRIATE.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05287-01-9
              

A. 7407                             2

  (B) SUCH COVERAGE MAY 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. Subsection (i) of section 3216 of the insurance law is amended by
adding a new paragraph 26 to read as follows:
  (26)(A)  EVERY  POLICY  DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
WHICH PROVIDES MEDICAL COVERAGE THAT  INCLUDES  COVERAGE  FOR  PHYSICIAN
SERVICES  IN  A PHYSICIAN'S OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR
MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE,  UPON  THE
PRESCRIPTION  OF  A HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE
UNDER TITLE EIGHT OF THE EDUCATION LAW, THE FOLLOWING COVERAGE FOR DIAG-
NOSTIC SCREENING FOR COLORECTAL CANCER:
  (I) STANDARD DIAGNOSTIC TESTING INCLUDING, BUT NOT LIMITED TO, A COLO-
NOSCOPY AND THE  MOST  RELIABLE,  MEDICALLY  RECOGNIZED  SCREENING  TEST
AVAILABLE AT ANY AGE FOR ANY PERSON HAVING A PRIOR HISTORY OF COLORECTAL
CANCER;
  (II)  AN  ANNUAL  STANDARD  DIAGNOSTIC  EXAMINATION INCLUDING, BUT NOT
LIMITED TO, A COLONOSCOPY AND THE  MOST  RELIABLE  MEDICALLY  RECOGNIZED
SCREENING TEST AVAILABLE FOR ANY PERSON AGE FIFTY AND OVER WHO IS ASYMP-
TOMATIC  AND  FOR ANY PERSON AGE FORTY AND OVER WITH A FAMILY HISTORY OF
COLORECTAL CANCER OR OTHER COLORECTAL CANCER RISK FACTORS; AND
  (III) ANY ANCILLARY SERVICE SUCH AS BUT NOT LIMITED TO  PATHOLOGY  AND
ANESTHESIOLOGY  THAT  THE  POLICYHOLDER'S  PHYSICIAN  DETERMINES  TO  BE
MEDICALLY NECESSARY AND APPROPRIATE.
  (B) SUCH COVERAGE MAY 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. This act shall take effect on the first of January next  succeed-
ing  the date on which it shall have become a law and shall apply to all
policies of life, accident and health insurance issued after such date.