S T A T E O F N E W Y O R K
________________________________________________________________________
903
2015-2016 Regular Sessions
I N A S S E M B L Y
January 8, 2015
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Introduced by M. of A. CYMBROWITZ, COLTON, GALEF, GUNTHER, JAFFEE,
ROBINSON, TITONE, ZEBROWSKI, CAHILL, TITUS -- Multi-Sponsored by -- M.
of A. BRENNAN, GLICK, GOTTFRIED, HOOPER -- read once and referred 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. Subsection (l) of section 3221 of the insurance law is
amended by adding a new paragraph 12-b to read as follows:
(12-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, THE FOLLOWING COVERAGE FOR DIAG-
NOSTIC SCREENING FOR COLORECTAL CANCER:
(I) STANDARD DIAGNOSTIC TESTING INCLUDING, BUT NOT LIMITED TO, A COLO-
NOSCOPY AND THE MOST RELIABLE, MEDICALLY RECOGNIZED SCREENING TEST
AVAILABLE AT ANY AGE FOR ANY PERSON HAVING A PRIOR HISTORY OF COLORECTAL
CANCER;
(II) AN ANNUAL STANDARD DIAGNOSTIC EXAMINATION INCLUDING, BUT NOT
LIMITED TO, A COLONOSCOPY AND THE MOST RELIABLE MEDICALLY RECOGNIZED
SCREENING TEST AVAILABLE FOR ANY PERSON AGE FIFTY AND OVER WHO IS ASYMP-
TOMATIC AND FOR ANY PERSON AGE FORTY AND OVER WITH A FAMILY HISTORY OF
COLORECTAL CANCER OR OTHER COLORECTAL CANCER RISK FACTORS; AND
(III) ANY ANCILLARY SERVICE SUCH AS BUT NOT LIMITED TO PATHOLOGY AND
ANESTHESIOLOGY THAT THE POLICYHOLDER'S PHYSICIAN DETERMINES TO BE
MEDICALLY NECESSARY AND APPROPRIATE.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05250-01-5
A. 903 2
(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 (i) of section 3216 of the insurance law is amended by
adding a new paragraph 32 to read as follows:
(32)(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, THE FOLLOWING COVERAGE FOR DIAG-
NOSTIC SCREENING FOR COLORECTAL CANCER:
(I) STANDARD DIAGNOSTIC TESTING INCLUDING, BUT NOT LIMITED TO, A COLO-
NOSCOPY AND THE MOST RELIABLE, MEDICALLY RECOGNIZED SCREENING TEST
AVAILABLE AT ANY AGE FOR ANY PERSON HAVING A PRIOR HISTORY OF COLORECTAL
CANCER;
(II) AN ANNUAL STANDARD DIAGNOSTIC EXAMINATION INCLUDING, BUT NOT
LIMITED TO, A COLONOSCOPY AND THE MOST RELIABLE MEDICALLY RECOGNIZED
SCREENING TEST AVAILABLE FOR ANY PERSON AGE FIFTY AND OVER WHO IS ASYMP-
TOMATIC AND FOR ANY PERSON AGE FORTY AND OVER WITH A FAMILY HISTORY OF
COLORECTAL CANCER OR OTHER COLORECTAL CANCER RISK FACTORS; AND
(III) ANY ANCILLARY SERVICE SUCH AS BUT NOT LIMITED TO PATHOLOGY AND
ANESTHESIOLOGY THAT THE POLICYHOLDER'S PHYSICIAN DETERMINES TO BE
MEDICALLY NECESSARY AND APPROPRIATE.
(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. 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 of life, accident and health insurance issued after such date.