S T A T E O F N E W Y O R K
________________________________________________________________________
4378--A
2011-2012 Regular Sessions
I N A S S E M B L Y
February 3, 2011
___________
Introduced by M. of A. ROSENTHAL, CAMARA, SPANO, GIBSON, GUNTHER,
BOYLAND, GOTTFRIED, MILLMAN, COLTON, CASTRO, MAISEL, HOOPER -- Multi-
Sponsored by -- M. of A. CAHILL, COOK, CRESPO, GIGLIO, GLICK,
JEFFRIES, MARKEY, McENENY, SCARBOROUGH, WEINSTEIN, WEISENBERG -- read
once and referred 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, the public health law and the execu-
tive 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) of paragraph 11 as added by chapter 417 of the laws of
1989 and subparagraph (C) of paragraph 15 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. Subsection (i) of section 3216 of the insurance law is amended by
adding a new paragraph 28 to read as follows:
(28) NO POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE WHICH
PROVIDES COVERAGE FOR SCREENING FOR COLON CANCER SHALL IMPOSE ANY COST-
SHARING, DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS.
S 3. Subparagraph (B) of paragraph 11 and subparagraph (C) of para-
graph 14 of subsection (1) of section 3221 of the insurance law, as
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01826-03-1
A. 4378--A 2
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 4. Subsection (a) of section 3221 of the insurance law is amended by
adding a new paragraph 17 to read as follows:
(17) NO POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE WHICH
PROVIDES COVERAGE FOR SCREENING FOR COLON CANCER SHALL IMPOSE ANY COST-
SHARING, DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS.
S 5. 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 6. Section 4303 of the insurance law is amended by adding a new
subsection (hh) to read as follows:
(HH) NO MEDICAL EXPENSE INDEMNITY CORPORATION, A HOSPITAL SERVICE
CORPORATION OR A HEALTH SERVICE CORPORATION WHICH PROVIDES COVERAGE FOR
SCREENING FOR COLON CANCER SHALL IMPOSE ANY COST-SHARING, DEDUCTIBLES OR
CO-INSURANCE OBLIGATIONS.
S 7. 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
A. 4378--A 3
shall apply to visits for the diagnosis and treatment of mental, nervous
or emotional disorders or ailments.
S 8. 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
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 9. Section 4406-c of the public health law is amended by adding a
new subdivision 8 to read as follows:
8. NO HEALTH MAINTENANCE ORGANIZATION WHICH PROVIDES COVERAGE FOR
SCREENING FOR COLON CANCER SHALL IMPOSE ANY COST-SHARING, DEDUCTIBLES OR
CO-INSURANCE OBLIGATIONS.
S 10. Subdivision 21 of section 296 of the executive law, as renum-
bered by chapter 536 of the laws of 2010, is renumbered subdivision 22
and a new subdivision 21 is added to read as follows:
21. IT SHALL BE AN UNLAWFUL DISCRIMINATORY PRACTICE FOR ANY EMPLOYER,
LABOR ORGANIZATION, INSURER, HEALTH MAINTENANCE ORGANIZATION OR OTHER
ENTITY TO IMPOSE ANY COST-SHARING, DEDUCTIBLES OR CO-INSURANCE OBLI-
GATIONS WHERE COVERAGE IS PROVIDED FOR SCREENING FOR COLON CANCER.
S 11. This act shall take effect immediately 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.