Senate Bill S543

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

                                   543

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  Sen. KENNEDY -- 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  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 30, paragraph 28 of subsection (i) of  section  3216  of
the  insurance  law,  as  amended  by chapter 11 of the laws of 2012, is
renumbered paragraph 31 and a new paragraph  32  is  added  to  read  as
follows:
  (32) (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.
              

                                                           LBD02479-02-3

S. 543                              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 19 to read as follows:
  (19) (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 financial services shall require an  insur-
er,  health  carrier or health benefit plan to notify enrollees annually
of colorectal cancer screenings covered by such enrollees' health  bene-
fit  plan  and  the  most  recently published guidelines of the American
College of Gastroenterology or the American Gastroenterological  Associ-
ation  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 Gastroen-

S. 543                              3

terology 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  financial
services 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.