NY State Senate Bill 2009-S6363

Senate Bill S6363

2009-2010 Legislative Session

Provides that health insurance policies shall include coverage for testing and screening for colorectal cancer

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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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 06, 2010	referred to insurance
Dec 30, 2009	referred to rules

2009-S6363 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L

2009-S6363 (ACTIVE) - Summary

Provides that health insurance policies shall include coverage for testing and screening for colorectal cancer.

2009-S6363 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S6363

 TITLE OF BILL :

An act to amend the insurance law, in relation to requiring certain
health insurance policies to cover diagnostic testing for colorectal
cancer


 PURPOSE :

To expand certain health insurance providers' coverage for colorectal
cancer screenings to individuals over the age of forty-five or to any
individuals who are considered to be at high risk for colorectal
cancer.

 SUMMARY OF PROVISIONS :

Adds a new paragraph 27 to of section 3215 subsection (i), section
3221 subsection (k), and section 4303 subsection (gg) of the insurance
law, providing that every health insurance policy shall include
coverage for colorectal cancer screenings for individuals over the age
of forty-five or for those individuals who have been deemed at high
risk for colorectal cancer. Coverage shall include various standard
diagnostic testing methods or any combination of such testing that the
policyholder's physician deems medically necessary and appropriate.

This paragraph also includes a definition of what constitutes "high
risk for colorectal cancer" for purposes of this section.

 JUSTIFICATION :

Colorectal cancer, cancer of the colon or rectum, is the third most
common cancer found in men and women and is the second leading cause
of cancer related deaths in the United States. However, colorectal
cancer, in its early stages, is one of the most curable forms of
cancer. When detected early, colorectal cancer is up to 90 percent
curable. Even so, less than one-half of colorectal cancers are
detected at an early stage, when they are most treatable. At least 60
percent of Americans age 50 and older have never been screened for
colorectal cancer. Colorectal screening is vital in securing early
detection of the disease, as there are often no early warning signs or
symptoms. This bill would ensure that colorectal cancer screening
methods are covered by all health insurance providers. By mandating
coverage for colorectal cancer screenings, lowering the age threshold
found in many insurance plans that offer such coverage to the age of
forty-five, as well as mandating coverage for individuals of any age
who are at high risk for colorectal cancer, this bill ensures that a
greater number of New Yorkers will have access to these potentially
life-saving procedures.

 LEGISLATIVE HISTORY :

This is a 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 have become a law and shall apply to all
policies of life, contracts and certificate issued, renewed, modified,
altered or amended on or after such effective date.

2009-S6363 (ACTIVE) - Bill Text download pdf

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

                                  6363

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                            December 30, 2009
                               ___________

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

AN ACT to amend the insurance law,  in  relation  to  requiring  certain
  health  insurance  policies to cover diagnostic testing for colorectal
  cancer

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

  Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
amended by adding a new paragraph 27 to read as follows:
  (27) (A) EVERY HEALTH INSURANCE POLICY DELIVERED OR ISSUED FOR  DELIV-
ERY 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 AUTHO-
RIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW, THE FOLLOWING
COVERAGE TO ANY PERSON OVER THE AGE OF FORTY-FIVE WHO IS ASYMPTOMATIC OR
ANY PERSON OF ANY AGE WHO IS CONSIDERED TO BE AT HIGH RISK FOR  COLOREC-
TAL CANCER:
  (I) STANDARD DIAGNOSTIC TESTING INCLUDING, BUT NOT LIMITED TO:
  (I) A COLONSCOPY;
  (II) FLEXIBLE SIGMOIDOSCOPY;
  (III) A SCREENING FECAL OCCULT BLOOD TEST;
  (IV) BARIUM ENEMA;
  (II) THE MOST RELIABLE, MEDICALLY RECOGNIZED SCREENING TEST AVAILABLE;
AND
  (III)   ANY  COMBINATION  OF  SUCH  TESTING  AND  SCREENING  THAT  THE
POLICYHOLDER'S PHYSICIAN DETERMINES TO BE MEDICALLY NECESSARY AND APPRO-
PRIATE.
  (B) FOR PURPOSES OF THIS SECTION, THE TERM "HIGH RISK  FOR  COLORECTAL
CANCER" SHALL INCLUDE:
  (I) A PERSONAL HISTORY OF COLORECTAL CANCER OR COLORECTAL POLYPS;

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD15138-02-9

S. 6363                             2

  (II) A STRONG FAMILY HISTORY OF THE DISEASE;
  (III)  AN  INHERITED GENETIC SUSCEPTIBILITY TO THE DISEASE, INCLUDING,
BUT NOT  LIMITED  TO,  FAMILIAL  ADENOMATOUS  POLYPOSIS  AND  HEREDITARY
NON-POLYPOSIS COLORECTAL CANCER;
  (IV)  A  PREDISPOSING CHRONIC DIGESTIVE CONDITION SUCH AS INFLAMMATORY
BOWEL DISEASE, INCLUDING CROHN'S DISEASE AND ULCERATIVE COLITIS; OR
  (V) A BACKGROUND, ETHNICITY OR LIFESTYLE THAT THE  PHYSICIAN  BELIEVES
PUTS THE PERSON AT ELEVATED RISK FOR COLORECTAL CANCER.
  (C) 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 (k) of section 3221 of the insurance law is amended by
adding a new paragraph 16 to read as follows:
  (16)(A)  EVERY  GROUP  HEALTH INSURANCE 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 TO ANY PERSON OVER  THE  AGE  OF  FORTY-FIVE  WHO  IS
ASYMPTOMATIC  OR  ANY  PERSON OF ANY AGE WHO IS CONSIDERED TO BE AT HIGH
RISK FOR COLORECTAL CANCER:
  (I) STANDARD DIAGNOSTIC TESTING INCLUDING, BUT NOT LIMITED TO:
  (I) A COLONOSCOPY;
  (II) FLEXIBLE SIGMOIDOSCOPY;
  (III) A SCREENING FECAL OCCULT BLOOD TEST;
  (IV) BARIUM ENEMA;
  (II) THE MOST RELIABLE, MEDICALLY RECOGNIZED SCREENING TEST AVAILABLE;
AND
  (III)  ANY  COMBINATION  OF  SUCH  TESTING  AND  SCREENING  THAT   THE
POLICYHOLDER'S PHYSICIAN DETERMINES TO BE MEDICALLY NECESSARY AND APPRO-
PRIATE.
  (B)  FOR  PURPOSES OF THIS SECTION, THE TERM "HIGH RISK FOR COLORECTAL
CANCER" SHALL INCLUDE:
  (I) A PERSONAL HISTORY OF COLORECTAL CANCER OR COLORECTAL POLYPS;
  (II) A STRONG FAMILY HISTORY OF THE DISEASE;
  (III) AN INHERITED GENETIC SUSCEPTIBILITY TO THE  DISEASE,  INCLUDING,
BUT  NOT  LIMITED  TO,  FAMILIAL  ADENOMATOUS  POLYPOSIS  AND HEREDITARY
NON-POLYPOSIS COLORECTAL CANCER;
  (IV) A PREDISPOSING CHRONIC DIGESTIVE CONDITION SUCH  AS  INFLAMMATORY
BOWEL DISEASE, INCLUDING CROHN'S DISEASE AND ULCERATIVE COLITIS; OR
  (V)  A  BACKGROUND, ETHNICITY OR LIFESTYLE THAT THE PHYSICIAN BELIEVES
PUTS THE PERSON AT ELEVATED RISK FOR COLORECTAL CANCER.
  (C) 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. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (gg) to read as follows:
  (GG) (1) EVERY HEALTH SERVICE CORPORATION OR A MEDICAL SERVICE EXPENSE
INDEMNITY  CORPORATION  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  TO  ANY  PERSON  OVER  THE AGE OF FORTY-FIVE WHO IS

S. 6363                             3

ASYMPTOMATIC OR ANY PERSON OF ANY AGE WHO IS CONSIDERED TO  BE  AT  HIGH
RISK FOR COLORECTAL CANCER:
  (A) STANDARD DIAGNOSTIC TESTING INCLUDING, BUT NOT LIMITED TO:
  (I) A COLONOSCOPY;
  (II) FLEXIBLE SIGMOIDOSCOPY;
  (III) A SCREENING FECAL OCCULT BLOOD TEST;
  (IV) BARIUM ENEMA;
  (B)  THE MOST RELIABLE, MEDICALLY RECOGNIZED SCREENING TEST AVAILABLE;
AND
  (C)  ANY  COMBINATION  OF  SUCH  TESTING  AND   SCREENING   THAT   THE
POLICYHOLDER'S PHYSICIAN DETERMINES TO BE MEDICALLY NECESSARY AND APPRO-
PRIATE.
  (2)  FOR  PURPOSES OF THIS SECTION, THE TERM "HIGH RISK FOR COLORECTAL
CANCER" SHALL INCLUDE:
  (A) A PERSONAL HISTORY OF COLORECTAL CANCER OR COLORECTAL POLYPS;
  (B) A STRONG FAMILY HISTORY OF THE DISEASE;
  (C) AN INHERITED GENETIC SUSCEPTIBILITY TO THE DISEASE, INCLUDING, BUT
NOT LIMITED TO, FAMILIAL ADENOMATOUS POLYPOSIS AND HEREDITARY  NON-POLY-
POSIS COLORECTAL CANCER;
  (D)  A  PREDISPOSING  CHRONIC DIGESTIVE CONDITION SUCH AS INFLAMMATORY
BOWEL DISEASE, INCLUDING CROHN'S DISEASE AND ULCERATIVE COLITIS; OR
  (E) A BACKGROUND, ETHNICITY OR LIFESTYLE THAT THE  PHYSICIAN  BELIEVES
PUTS THE PERSON AT ELEVATED RISK FOR COLORECTAL CANCER.
  (3) 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  4. 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 accord-
ing to its terms to all policies,  contracts  and  certificates  issued,
renewed, modified, altered or amended on or after such effective date.

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