S T A T E O F N E W Y O R K
________________________________________________________________________
552
2011-2012 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 5, 2011
___________
Introduced by M. of A. DINOWITZ, CLARK, V. LOPEZ, GALEF, MILLMAN,
CUSICK, CYMBROWITZ, McENENY, ZEBROWSKI, ORTIZ, ENGLEBRIGHT -- Multi-
Sponsored by -- M. of A. BING, BRENNAN, CAHILL, CANESTRARI, COLTON,
COOK, GLICK, GOTTFRIED, JACOBS, PHEFFER, RAIA, SCARBOROUGH, 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. Paragraph 27 of subsection (i) of section 3216 of the
insurance law, as added by chapter 457 of the laws of 2010, is renum-
bered paragraph 28 and a new paragraph 29 is added to read as follows:
(29) (A) EVERY POLICY WHICH PROVIDES COVERAGE PURSUANT TO THIS SECTION
SHALL PROVIDE COVERAGE TO ANY NAMED SUBSCRIBER OR OTHER PERSON COVERED
THEREUNDER FOR EXPENSES INCURRED IN CONDUCTING COLORECTAL CANCER EXAM-
INATIONS AND LABORATORY TESTS AT REGULAR INTERVALS, INCLUDING EXPENSES
INCURRED IN CONDUCTING PHYSICIAN CONSULTATIONS FOR COLORECTAL CANCER
PRIOR TO SUCH EXAMINATIONS AND TESTS, FOR PERSONS FIFTY YEARS OF AGE OR
OLDER AND FOR PERSONS OF ANY AGE WHO ARE CONSIDERED TO BE AT HIGH RISK
FOR COLORECTAL CANCER. THE METHODS OF SCREENING FOR WHICH BENEFITS SHALL
BE PROVIDED SHALL INCLUDE BUT NOT BE LIMITED TO:
(I) A SCREENING FECAL OCCULT BLOOD TEST;
(II) FLEXIBLE SIGMOIDOSCOPY;
(III) COLONOSCOPY;
(IV) BARIUM ENEMA; OR
(V) THE MOST RELIABLE, MEDICALLY RECOGNIZED SCREENING TEST AVAILABLE;
AND
(VI) ANY COMBINATION THEREOF.
THE METHOD AND FREQUENCY OF SCREENING TO BE UTILIZED SHALL BE IN
ACCORD WITH THE MOST RECENTLY PUBLISHED GUIDELINES OF THE AMERICAN
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04462-01-1
A. 552 2
COLLEGE OF GASTROENTEROLOGY OR THE AMERICAN GASTROENTEROLOGICAL ASSOCI-
ATION IN CONSULTATION WITH THE AMERICAN CANCER SOCIETY.
(B) AS USED IN THIS PARAGRAPH, "HIGH RISK FOR COLORECTAL CANCER" SHALL
MEAN A PERSON HAS,
(I) A FAMILY HISTORY OF FAMILIAL ADENOMATOUS POLYPOSIS; HEREDITARY
NON-POLYPOSIS COLON CANCER; OR BREAST, OVARIAN, ENDOMETRIAL OR COLON
CANCER OR POLYPS;
(II) CHRONIC INFLAMMATORY BOWEL DISEASE; OR
(III) A BACKGROUND, ETHNICITY OR LIFESTYLE THAT THE PHYSICIAN BELIEVES
PUTS THE PERSON AT ELEVATED RISK FOR COLORECTAL CANCER.
S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 17 to read as follows:
(17) (A) EVERY POLICY WHICH PROVIDES COVERAGE PURSUANT TO THIS SECTION
SHALL PROVIDE COVERAGE TO ANY NAMED SUBSCRIBER OR OTHER PERSON COVERED
THEREUNDER FOR EXPENSES INCURRED IN CONDUCTING COLORECTAL CANCER EXAM-
INATIONS AND LABORATORY TESTS AT REGULAR INTERVALS, INCLUDING EXPENSES
INCURRED IN CONDUCTING PHYSICIAN CONSULTATIONS FOR COLORECTAL CANCER
PRIOR TO SUCH EXAMINATIONS AND TESTS, FOR PERSONS FIFTY YEARS OF AGE OR
OLDER AND FOR PERSONS OF ANY AGE WHO ARE CONSIDERED TO BE AT HIGH RISK
FOR COLORECTAL CANCER. THE METHODS OF SCREENING FOR WHICH BENEFITS SHALL
BE PROVIDED SHALL INCLUDE BUT NOT BE LIMITED TO:
(I) A SCREENING FECAL OCCULT BLOOD TEST;
(II) FLEXIBLE SIGMOIDOSCOPY;
(III) COLONOSCOPY;
(IV) BARIUM ENEMA; OR
(V) THE MOST RELIABLE, MEDICALLY RECOGNIZED SCREENING TEST AVAILABLE;
AND
(VI) ANY COMBINATION THEREOF.
THE METHOD AND FREQUENCY OF SCREENING TO BE UTILIZED SHALL BE IN
ACCORD WITH THE MOST RECENTLY PUBLISHED GUIDELINES OF THE AMERICAN
COLLEGE OF GASTROENTEROLOGY OR THE AMERICAN GASTROENTEROLOGICAL ASSOCI-
ATION IN CONSULTATION WITH THE AMERICAN CANCER SOCIETY.
(B) AS USED IN THIS PARAGRAPH, "HIGH RISK FOR COLORECTAL CANCER" SHALL
MEAN A PERSON HAS,
(I) A FAMILY HISTORY OF FAMILIAL ADENOMATOUS POLYPOSIS; HEREDITARY
NON-POLYPOSIS COLON CANCER; OR BREAST, OVARIAN, ENDOMETRIAL OR COLON
CANCER OR POLYPS;
(II) CHRONIC INFLAMMATORY BOWEL DISEASE; OR
(III) A BACKGROUND, ETHNICITY OR LIFESTYLE THAT THE PHYSICIAN BELIEVES
PUTS THE PERSON AT ELEVATED RISK FOR COLORECTAL CANCER.
S 3. Subsection (a) of section 4303 of the insurance law is amended by
adding a new paragraph 4 to read as follows:
(4) TO PERSONS FIFTY YEARS OF AGE OR OLDER FOR SERVICES RELATED TO THE
CONDUCTING OF COLORECTAL CANCER EXAMINATIONS AND LABORATORY TESTS AT
REGULAR INTERVALS, INCLUDING EXPENSES INCURRED IN CONDUCTING PHYSICIAN
CONSULTATIONS FOR COLORECTAL CANCER PRIOR TO SUCH EXAMINATIONS AND
TESTS, INCLUDING BUT NOT LIMITED TO, COLONOSCOPIES, COLOSCOPIES, SCREEN-
ING FECAL OCCULT BLOOD TESTS, FLEXIBLE SIGMOIDOSCOPIES OR BARIUM ENEMAS.
S 4. The superintendent of insurance shall require an insurer, health
carrier or health benefit plan to notify enrollees annually of colorec-
tal cancer screenings covered by such enrollees' health benefit plan and
the most recently published guidelines of the American College of
Gastroenterology or the American Gastroenterological Association in
consultation with the American Cancer Society for colorectal cancer
screenings or notify enrollees at intervals consistent with the most
recently published guidelines of the American College of Gastroenterolo-
A. 552 3
gy or the American Gastroenterological Association in consultation with
the American Cancer Society of colorectal cancer screenings which are
covered by such enrollees' health benefit plans. The notice shall be
delivered by mail unless the enrollee and health carrier have agreed on
another method of notification. The superintendent of insurance is
authorized to promulgate necessary rules and regulations for the
purposes of providing such notification.
S 5. This act shall take effect immediately and shall apply to any
policy issued, delivered, renewed, and/or modified on or after the
effective date of this act.