S T A T E O F N E W Y O R K
________________________________________________________________________
4238
2013-2014 Regular Sessions
I N A S S E M B L Y
February 1, 2013
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Introduced by M. of A. PRETLOW, JAFFEE -- Multi-Sponsored by -- M. of A.
CAHILL, CLARK, COOK, CUSICK, DINOWITZ, GALEF, GLICK, HOOPER, JACOBS,
V. LOPEZ, MAGEE, MILLMAN, ORTIZ, PERRY, SCARBOROUGH, SWEENEY, WEIN-
STEIN, WEISENBERG, WRIGHT -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to health insurance
coverage for diagnostic testing for ovarian cancer
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 DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
WHICH PROVIDES MEDICAL COVERAGE THAT INCLUDES COVERAGE FOR PHYSICIAN
SERVICES IN A PHYSICIAN'S OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR
MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE, UPON THE
PRESCRIPTION OF A HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE
UNDER TITLE EIGHT OF THE EDUCATION LAW, COVERAGE FOR DIAGNOSTIC TESTING
FOR OVARIAN CANCER, INCLUDING A PELVIC EXAMINATION, A SONOGRAM, A CA 125
BLOOD TEST AND LABORATORY AND DIAGNOSTIC SERVICES PROVIDED IN CONNECTION
WITH EXAMINING AND EVALUATING SUCH BLOOD TEST FOR WOMEN AGED FORTY AND
OVER WITH ONE OR MORE FEMALE RELATIVES WITH A PRIOR HISTORY OF OVARIAN
CANCER.
(B) SUCH 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 (l) 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 WHICH DELIVERS OR ISSUES FOR DELIVERY IN THIS
STATE A POLICY WHICH PROVIDES MEDICAL COVERAGE THAT INCLUDES COVERAGE
FOR PHYSICIAN SERVICES IN A PHYSICIAN'S OFFICE OR MAJOR MEDICAL OR SIMI-
LAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE, UPON THE PRESCRIPTION OF
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD07577-01-3
A. 4238 2
A HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT
OF THE EDUCATION LAW, COVERAGE FOR DIAGNOSTIC TESTING FOR OVARIAN
CANCER, INCLUDING A PELVIC EXAMINATION, A SONOGRAM, A CA 125 BLOOD TEST
AND LABORATORY AND DIAGNOSTIC SERVICES PROVIDED IN CONNECTION WITH EXAM-
INING AND EVALUATING SUCH BLOOD TEST FOR WOMEN AGED FORTY AND OVER WITH
ONE OR MORE FEMALE RELATIVES WITH A PRIOR HISTORY OF OVARIAN CANCER.
(B) SUCH 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 (jj) to read as follows:
(JJ) (1) A HOSPITAL SERVICE CORPORATION, MEDICAL EXPENSE INDEMNITY
CORPORATION OR HEALTH SERVICE CORPORATION WHICH PROVIDES MEDICAL COVER-
AGE THAT INCLUDES COVERAGE FOR PHYSICIAN SERVICES IN A PHYSICIAN'S
OFFICE OR MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL
PROVIDE, UPON THE PRESCRIPTION OF A HEALTH CARE PROVIDER LEGALLY AUTHOR-
IZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW, COVERAGE FOR
DIAGNOSTIC TESTING FOR OVARIAN CANCER, INCLUDING A PELVIC EXAMINATION, A
SONOGRAM, A CA 125 BLOOD TEST AND LABORATORY AND DIAGNOSTIC SERVICES
PROVIDED IN CONNECTION WITH EXAMINING AND EVALUATING SUCH BLOOD TEST FOR
WOMEN AGED FORTY AND OVER WITH ONE OR MORE FEMALE RELATIVES WITH A PRIOR
HISTORY OF OVARIAN CANCER.
(2) SUCH 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 first of January next succeed-
ing the date on which it shall have become a law and shall apply to all
policies issued, renewed, altered or modified on or after such effective
date.