Senate Bill S5373

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

                                  5373

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              May 16, 2013
                               ___________

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

AN ACT to amend the insurance  law,  in  relation  to  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.  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.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06910-04-3

              

S. 5373                             2

  (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 2. 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.
  (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  3.  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  OVARIAN  CANCER,  POSITIVE
GENETIC  TESTING  OR  OTHER  INDICATIONS  AS DETERMINED BY SUCH PERSON'S
PHYSICIAN OR NURSE PRACTITIONER.

S. 5373                             3

  (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  4.  This  act  shall take effect on the sixtieth day after it shall
have become a law.