S T A T E O F N E W Y O R K
________________________________________________________________________
323
2015-2016 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 7, 2015
___________
Introduced by M. of A. ROZIC, CRESPO, AUBRY, ABINANTI, BORELLI, COLTON,
COOK, GRAF, GUNTHER, JAFFEE, LUPINACCI, MONTESANO, MOYA, OTIS, PERRY,
ROBINSON, SCARBOROUGH, SEPULVEDA, SKOUFIS, STECK, TITUS, WEPRIN --
Multi-Sponsored by -- M. of A. ARROYO, BRENNAN, CERETTO, CLARK,
CROUCH, MAGEE, MOSLEY, RA, RIVERA, ROBERTS, SCHIMEL, SIMANOWITZ, SKAR-
TADOS, TITONE -- 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 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
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01732-01-5
A. 323 2
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 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 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
A. 323 3
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.
(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.