S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5302
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             February 20, 2025
                                ___________
 
 Introduced  by Sen. SCARCELLA-SPANTON -- 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 requiring coverage for
   colorectal cancer early detection beginning at age thirty-five
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Paragraph  11-b  of subsection (l) of section 3221 of the
 insurance law, as amended by chapter 78 of the laws of 2023, is  amended
 to read as follows:
   (11-b)  (A)  Every large group 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 large group  policy
 which  provides  major  medical  or  similar comprehensive-type coverage
 shall provide, upon the prescription of a health  care  provider  acting
 within  the  provider's scope of practice pursuant to title eight of the
 education law, coverage for colorectal cancer preventive  screenings  in
 accordance  with  the  American Cancer Society Guidelines for colorectal
 cancer screening of average risk individuals, EXCEPT THAT SUCH  COVERAGE
 SHALL  BE PROVIDED TO ALL INDIVIDUALS BEGINNING AT AGE THIRTY-FIVE.  The
 coverage required by this paragraph shall also include coverage for  all
 additional  colorectal  cancer  examinations and laboratory tests recom-
 mended in accordance with the American  Cancer  Society  Guidelines  for
 colorectal  cancer  screening  of  average risk individuals, EXCEPT THAT
 SUCH COVERAGE SHALL BE PROVIDED TO  ALL  INDIVIDUALS  BEGINNING  AT  AGE
 THIRTY-FIVE,  including  an initial colonoscopy or other medical test or
 procedure for colorectal cancer screening and  a  follow-up  colonoscopy
 performed  as a result of a positive result on a non-colonoscopy preven-
 tive screening test. A large group policy shall cover colorectal  cancer
 screenings,  examinations,  and laboratory tests described in this para-
 graph upon any policy issuance or renewal that occurs six  months  after
 the date the guideline described in this paragraph is issued.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07807-01-5
              

 S. 5302                             2
 
   (B)  An  insured shall not be subject to a deductible, coinsurance, or
 any other cost-sharing requirements for services consistent with subpar-
 agraph (A) of this paragraph received from participating providers.
   § 2. Subsection (uu) of section 4303 of the insurance law, as added by
 chapter 78 of the laws of 2023, is amended to read as follows:
   (uu)  (1)  Every large group contract 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  large  group
 contract  which  provides  major  medical  or similar comprehensive-type
 coverage shall provide, upon the prescription of a health care  provider
 acting  within  the provider's scope of practice pursuant to title eight
 of the education law, coverage for colorectal cancer preventive  screen-
 ings in accordance with the American Cancer Society Guidelines for colo-
 rectal  cancer  screening  of average risk individuals, EXCEPT THAT SUCH
 COVERAGE SHALL BE PROVIDED TO ALL INDIVIDUALS BEGINNING AT  AGE  THIRTY-
 FIVE.    The  coverage  required  by  this subsection shall also include
 coverage for all additional colorectal cancer examinations and laborato-
 ry tests recommended in accordance  with  the  American  Cancer  Society
 Guidelines  for colorectal cancer screening of average risk individuals,
 EXCEPT THAT SUCH COVERAGE SHALL BE PROVIDED TO ALL INDIVIDUALS BEGINNING
 AT AGE THIRTY-FIVE, including an initial colonoscopy  or  other  medical
 test  or procedure for colorectal cancer screening and a follow-up colo-
 noscopy performed as a result of a positive result on a  non-colonoscopy
 preventive screening test. A large group contract shall cover colorectal
 cancer  screenings, examinations, and laboratory tests described in this
 subsection upon any contract issuance or renewal that occurs six  months
 after the date the guideline described in this subsection is issued.
   (2)  An enrollee shall not be subject to a deductible, coinsurance, or
 any other cost-sharing requirements for services consistent  with  para-
 graph one of this subsection received from participating providers.
   § 3. 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  ACTING  WITHIN  THE  PROVIDER'S
 SCOPE OF PRACTICE PURSUANT TO TITLE EIGHT OF THE EDUCATION LAW, COVERAGE
 FOR COLORECTAL CANCER PREVENTIVE SCREENINGS IN ACCORDANCE WITH THE AMER-
 ICAN  CANCER SOCIETY GUIDELINES FOR COLORECTAL CANCER SCREENING OF AVER-
 AGE RISK INDIVIDUALS, EXCEPT THAT SUCH COVERAGE SHALL BE PROVIDED TO ALL
 INDIVIDUALS BEGINNING AT AGE THIRTY-FIVE. THE COVERAGE REQUIRED BY  THIS
 SUBSECTION  SHALL  ALSO  INCLUDE  COVERAGE FOR ALL ADDITIONAL COLORECTAL
 CANCER EXAMINATIONS AND LABORATORY TESTS RECOMMENDED IN ACCORDANCE  WITH
 THE  AMERICAN  CANCER SOCIETY GUIDELINES FOR COLORECTAL CANCER SCREENING
 OF AVERAGE RISK INDIVIDUALS, EXCEPT THAT SUCH COVERAGE SHALL BE PROVIDED
 TO ALL INDIVIDUALS BEGINNING AT AGE THIRTY-FIVE,  INCLUDING  AN  INITIAL
 COLONOSCOPY  OR  OTHER  MEDICAL  TEST OR PROCEDURE FOR COLORECTAL CANCER
 SCREENING AND A FOLLOW-UP COLONOSCOPY PERFORMED AS A RESULT OF  A  POSI-
 TIVE  RESULT  ON  A  NON-COLONOSCOPY PREVENTIVE SCREENING TEST. A POLICY
 SHALL COVER COLORECTAL CANCER SCREENINGS, EXAMINATIONS,  AND  LABORATORY
 TESTS  DESCRIBED  IN THIS SUBSECTION UPON ANY POLICY ISSUANCE OR RENEWAL
 THAT OCCURS SIX MONTHS AFTER THE DATE THE GUIDELINE  DESCRIBED  IN  THIS
 SUBSECTION IS ISSUED.
 S. 5302                             3
 
   (B)  AN ENROLLEE SHALL NOT BE SUBJECT TO A DEDUCTIBLE, COINSURANCE, OR
 ANY OTHER COST-SHARING REQUIREMENTS FOR SERVICES CONSISTENT WITH SUBPAR-
 AGRAPH (A) OF THIS PARAGRAPH RECEIVED FROM PARTICIPATING PROVIDERS.
   §  4.  Section 339 of the insurance law, as added by chapter 78 of the
 laws of 2023, is amended to read as follows:
   § 339. Colorectal cancer screening  notification.  The  superintendent
 shall  require an insurer authorized to write accident and health insur-
 ance in this state, a corporation organized pursuant to  article  forty-
 three  of  this chapter, and a health maintenance organization certified
 pursuant to article forty-four  of  the  public  health  law  to  notify
 insureds  and  enrollees  AGE THIRTY-FIVE AND ABOVE at least annually of
 colorectal cancer screenings covered by  such  insureds'  or  enrollees'
 health  insurance policy or contract, and of the most recently published
 guidelines of the American Cancer Society for colorectal cancer  screen-
 ings  that  are covered by such insureds' or enrollees' health insurance
 policy or contract. The notice  shall  be  delivered  by  United  States
 postal mail unless the insured or enrollee consents to another method of
 notification, including electronic notification.
   §  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.