S T A T E O F N E W Y O R K
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10536
I N A S S E M B L Y
June 4, 2012
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Introduced by COMMITTEE ON RULES -- (at request of M. of A. Espinal) --
read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to requiring health
insurance policies to cover comprehensive ultrasound screening, genet-
ic testing, magnetic resonance imaging and/or other screening tests
for breast cancer in certain cases, requiring the provision of certain
information relating to breast density to patients; and requiring
health insurance policies to cover comprehensive tests for ovarian
cancer in certain cases
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 11 of subsection (i) of section 3216 of the
insurance law is amended by adding a new subparagraph (F) to read as
follows:
(F) (I) SUCH POLICY SHALL PROVIDE ADDITIONAL COVERAGE FOR COMPREHEN-
SIVE ULTRASOUND SCREENING, GENETIC TESTING, MAGNETIC RESONANCE IMAGING
(MRI), AND/OR OTHER SCREENING TESTS APPROVED BY THE AMERICAN COLLEGE OF
RADIOLOGY OF AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
(I) A MAMMOGRAM DEMONSTRATES HETEROGENEOUS OR DENSE BREAST TISSUE
BASED ON THE BREAST IMAGING REPORTING AND DATA SYSTEM ESTABLISHED BY THE
AMERICAN COLLEGE OF RADIOLOGY; OR
(II) A WOMAN IS BELIEVED TO BE AT INCREASED RISK FOR BREAST CANCER DUE
TO FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF BREAST CANCER, POSITIVE
GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY SUCH WOMAN'S
PHYSICIAN OR NURSE PRACTITIONER.
(II) SUCH ADDITIONAL 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.
(III) EACH MAMMOGRAPHY REPORT PROVIDED TO A PATIENT SHALL INCLUDE
INFORMATION ABOUT BREAST DENSITY, BASED ON THE BREAST IMAGING REPORTING
AND DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY. WHERE
APPLICABLE, SUCH REPORT SHALL INCLUDE THE FOLLOWING NOTICE: "IF YOUR
MAMMOGRAM DEMONSTRATES THAT YOU HAVE DENSE BREAST TISSUE, WHICH COULD
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD16101-02-2
A. 10536 2
HIDE SMALL ABNORMALITIES, YOU MIGHT BENEFIT FROM SUPPLEMENTARY SCREENING
TESTS, DEPENDING ON YOUR INDIVIDUAL RISK FACTORS AND THE RECOMMENDATION
OF YOUR INTERPRETING PHYSICIAN. A REPORT OF YOUR MAMMOGRAPHY RESULTS,
WHICH CONTAINS INFORMATION ABOUT YOUR BREAST DENSITY, HAS BEEN SENT TO
YOUR TREATING PHYSICIAN'S OFFICE AND YOU SHOULD CONTACT YOUR TREATING
PHYSICIAN IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR REPORT."
S 2. Paragraph 11 of subsection (l) of section 3221 of the insurance
law is amended by adding a new subparagraph (F) to read as follows:
(F) (I) SUCH POLICY SHALL PROVIDE ADDITIONAL COVERAGE FOR COMPREHEN-
SIVE ULTRASOUND SCREENING, GENETIC TESTING, MAGNETIC RESONANCE IMAGING
(MRI), AND/OR OTHER SCREENING TESTS APPROVED BY THE AMERICAN COLLEGE OF
RADIOLOGY OF AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
(I) A MAMMOGRAM DEMONSTRATES HETEROGENEOUS OR DENSE BREAST TISSUE
BASED ON THE BREAST IMAGING REPORTING AND DATA SYSTEM ESTABLISHED BY THE
AMERICAN COLLEGE OF RADIOLOGY; OR
(II) A WOMAN IS BELIEVED TO BE AT AN INCREASED RISK FOR BREAST CANCER
DUE TO FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF BREAST CANCER, POSI-
TIVE GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY SUCH WOMAN'S
PHYSICIAN OR NURSE PRACTITIONER.
(II) SUCH ADDITIONAL 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.
(III) EACH MAMMOGRAPHY REPORT PROVIDED TO A PATIENT SHALL INCLUDE
INFORMATION ABOUT BREAST DENSITY, BASED ON THE BREAST IMAGING REPORTING
AND DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY. WHERE
APPLICABLE, SUCH REPORT SHALL INCLUDE THE FOLLOWING NOTICE: "IF YOUR
MAMMOGRAM DEMONSTRATES THAT YOU HAVE DENSE BREAST TISSUE, WHICH COULD
HIDE SMALL ABNORMALITIES, YOU MIGHT BENEFIT FROM SUPPLEMENTARY SCREENING
TESTS, DEPENDING ON YOUR INDIVIDUAL RISK FACTORS AND THE RECOMMENDATION
OF YOUR INTERPRETING PHYSICIAN. A REPORT OF YOUR MAMMOGRAPHY RESULTS,
WHICH CONTAINS INFORMATION ABOUT YOUR BREAST DENSITY, HAS BEEN SENT TO
YOUR TREATING PHYSICIAN'S OFFICE AND YOU SHOULD CONTACT YOUR TREATING
PHYSICIAN IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR REPORT."
S 3. Subsection (p) of section 4303 of the insurance law is amended by
adding a new paragraph 5 to read as follows:
(5) (A) SUCH COVERAGE SHALL PROVIDE ADDITIONAL COVERAGE FOR COMPREHEN-
SIVE ULTRASOUND SCREENING, GENETIC TESTING, MAGNETIC RESONANCE IMAGING
(MRI), AND/OR OTHER SCREENING TESTS APPROVED BY THE AMERICAN COLLEGE OF
RADIOLOGY OF AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
(I) A MAMMOGRAM DEMONSTRATES HETEROGENEOUS OR DENSE BREAST TISSUE
BASED ON THE BREAST IMAGING REPORTING AND DATA SYSTEM ESTABLISHED BY THE
AMERICAN COLLEGE OF RADIOLOGY; OR
(II) A WOMAN IS BELIEVED TO BE AT INCREASED RISK FOR BREAST CANCER DUE
TO FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF BREAST CANCER, POSITIVE
GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY SUCH WOMAN'S
PHYSICIAN OR NURSE PRACTITIONER.
THE ADDITIONAL COVERAGE REQUIRED IN THIS SUBPARAGRAPH 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.
(B) EACH MAMMOGRAPHY REPORT PROVIDED TO A PATIENT SHALL INCLUDE INFOR-
MATION ABOUT BREAST DENSITY, BASED ON THE BREAST IMAGING REPORTING AND
DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY. WHERE
APPLICABLE, SUCH REPORT SHALL INCLUDE THE FOLLOWING NOTICE: "IF YOUR
MAMMOGRAM DEMONSTRATES THAT YOU HAVE DENSE BREAST TISSUE, WHICH COULD
A. 10536 3
HIDE SMALL ABNORMALITIES, YOU MIGHT BENEFIT FROM SUPPLEMENTARY SCREENING
TESTS, DEPENDING ON YOUR INDIVIDUAL RISK FACTORS AND THE RECOMMENDATION
OF YOUR INTERPRETING PHYSICIAN. A REPORT OF YOUR MAMMOGRAPHY RESULTS,
WHICH CONTAINS INFORMATION ABOUT YOUR BREAST DENSITY, HAS BEEN SENT TO
YOUR TREATING PHYSICIAN'S OFFICE AND YOU SHOULD CONTACT YOUR TREATING
PHYSICIAN IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR REPORT."
S 4. Paragraph 7 of subsection (d) of section 4326 of the insurance
law, as added by chapter 1 of the laws of 1999, is amended to read as
follows:
(7) adult preventive health services consisting of mammography screen-
ing, AS PROVIDED IN SUBSECTION (P) OF SECTION FOUR THOUSAND THREE
HUNDRED THREE OF THIS ARTICLE; OVARIAN CANCER SCREENING AS PROVIDED IN
SUBSECTION (P-1) OF SECTION FOUR THOUSAND THREE HUNDRED THREE OF THIS
ARTICLE; cervical cytology screening; periodic physical examinations no
more than once every three years; and adult immunizations;
S 5. Subsection (i) of section 3216 of the insurance law is amended by
adding a new paragraph 11-b to read as follows:
(11-B) (A) EVERY POLICY THAT PROVIDES COVERAGE FOR HOSPITAL, SURGICAL
OR MEDICAL CARE SHALL PROVIDE THE FOLLOWING COVERAGE FOR SCREENING FOR
OVARIAN CANCER:
(I) UPON THE RECOMMENDATION OF A PHYSICIAN, A PELVIC EXAM, GENETIC
TESTING, ULTRASOUND AND BLOOD TESTING AT ANY AGE FOR COVERED PERSONS
HAVING A HIGH RISK OF DEVELOPING OVARIAN CANCER OR WHO HAVE A FIRST
DEGREE RELATIVE WITH A PRIOR HISTORY OF OVARIAN CANCER;
(II) A SINGLE BASELINE ULTRASOUND FOR COVERED PERSONS AGED THIRTY-FIVE
THROUGH THIRTY-NINE, INCLUSIVE; AND
(III) AN ANNUAL ULTRASOUND FOR COVERED PERSONS AGED FORTY AND OLDER.
(B) SUCH COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS PARA-
GRAPH 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.
(C) (I) SUCH POLICY SHALL PROVIDE FOR ADDITIONAL COVERAGE FOR COMPUTED
TOMOGRAPHY, BARIUM ENEMA X-RAYS, MAGNETIC RESONANCE IMAGING (MRI), POSI-
TRON EMISSION TOMOGRAPHY, LAPAROSCOPY, COLONOSCOPY AND BIOPSY IF A
PERSON IS BELIEVED TO BE AT INCREASED RISK FOR OVARIAN CANCER DUE TO
FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF OVARIAN CANCER, POSITIVE
GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY SUCH PERSON'S
PHYSICIAN OR NURSE PRACTITIONER.
(II) SUCH ADDITIONAL 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 6. Subsection (1) of section 3221 of the insurance law is amended by
adding a new paragraph 11-b to read as follows:
(11-B) (A) EVERY INSURER DELIVERING A GROUP OR BLANKET POLICY OR ISSU-
ING A GROUP OR BLANKET POLICY FOR DELIVERY IN THIS STATE THAT PROVIDES
COVERAGE FOR HOSPITAL, SURGICAL OR MEDICAL CARE SHALL PROVIDE THE
FOLLOWING COVERAGE FOR SCREENING FOR OVARIAN CANCER:
(I) UPON THE RECOMMENDATION OF A PHYSICIAN, A PELVIC EXAM, GENETIC
TESTING, ULTRASOUND AND BLOOD TESTING AT ANY AGE FOR COVERED PERSONS
HAVING A HIGH RISK OF DEVELOPING OVARIAN CANCER OR WHO HAVE A FIRST
DEGREE RELATIVE WITH A PRIOR HISTORY OF OVARIAN CANCER;
(II) A SINGLE BASELINE ULTRASOUND FOR COVERED PERSONS AGED THIRTY-FIVE
THROUGH THIRTY-NINE, INCLUSIVE; AND
(III) AN ANNUAL ULTRASOUND FOR COVERED PERSONS AGED FORTY AND OLDER.
A. 10536 4
(B) SUCH COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS PARA-
GRAPH 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.
(C) (I) SUCH POLICY SHALL PROVIDE FOR ADDITIONAL COVERAGE FOR COMPUTED
TOMOGRAPHY, BARIUM ENEMA X-RAYS, MAGNETIC RESONANCE IMAGING (MRI), POSI-
TRON EMISSION TOMOGRAPHY, LAPAROSCOPY, COLONOSCOPY AND BIOPSY IF A
PERSON IS BELIEVED TO BE AT INCREASED RISK FOR OVARIAN CANCER DUE TO
FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF OVARIAN CANCER, POSITIVE
GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY SUCH PERSON'S
PHYSICIAN OR NURSE PRACTITIONER.
(II) SUCH ADDITIONAL 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 7. Section 4303 of the insurance law is amended by adding a new
subsection (p-1) to read as follows:
(P-1) (1) A MEDICAL EXPENSE INDEMNITY CORPORATION, A HOSPITAL SERVICE
CORPORATION OR A HEALTH SERVICE CORPORATION THAT PROVIDES COVERAGE FOR
HOSPITAL, SURGICAL OR MEDICAL CARE SHALL PROVIDE THE FOLLOWING COVERAGE
FOR SCREENING FOR OVARIAN CANCER:
(A) UPON THE RECOMMENDATION OF A PHYSICIAN, A PELVIC EXAM, GENETIC
TESTING, ULTRASOUND AND BLOOD TESTING AT ANY AGE FOR COVERED PERSONS
HAVING A HIGH RISK OF DEVELOPING OVARIAN CANCER OR WHO HAVE A FIRST
DEGREE RELATIVE WITH A PRIOR HISTORY OF OVARIAN CANCER;
(B) A SINGLE BASELINE ULTRASOUND FOR COVERED PERSONS AGED THIRTY-FIVE
THROUGH THIRTY-NINE, INCLUSIVE; AND
(C) AN ANNUAL ULTRASOUND FOR COVERED PERSONS AGED FORTY AND OLDER.
(2) SUCH COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS PARA-
GRAPH 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.
(3) (A) SUCH POLICY SHALL PROVIDE FOR ADDITIONAL COVERAGE FOR COMPUTED
TOMOGRAPHY, BARIUM ENEMA X-RAYS, MAGNETIC RESONANCE IMAGING (MRI), POSI-
TRON EMISSION TOMOGRAPHY, LAPAROSCOPY, COLONOSCOPY AND BIOPSY IF A
PERSON IS BELIEVED TO BE AT INCREASED RISK FOR OVARIAN CANCER DUE TO
FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF OVARAIN CANCER, POSITIVE
GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY SUCH PERSON'S
PHYSICIAN OR NURSE PRACTITIONER.
(B) SUCH ADDITIONAL 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 8. This act shall take effect on the sixtieth day after it shall
have become a law.