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.