S05373 Summary:

BILL NO    S05373 

SAME AS    SAME AS A08473

SPONSOR    SAVINO

COSPNSR    AVELLA

MLTSPNSR   

Amd SS3216, 3221 & 4303, Ins L

Requires health insurance policies to cover comprehensive screening for ovarian
cancer.
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S05373 Actions:

BILL NO    S05373 

05/16/2013 REFERRED TO INSURANCE
01/08/2014 REFERRED TO INSURANCE
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S05373 Text:

                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________

                                         5373

                              2013-2014 Regular Sessions

                                   I N  S E N A T E

                                     May 16, 2013
                                      ___________

       Introduced  by  Sen.  SAVINO -- 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  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:

    1    Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
    2  amended by adding a new paragraph 11-b to read as follows:
    3    (11-B) (A) EVERY POLICY THAT PROVIDES COVERAGE FOR HOSPITAL,  SURGICAL
    4  OR  MEDICAL  CARE SHALL PROVIDE THE FOLLOWING COVERAGE FOR SCREENING FOR
    5  OVARIAN CANCER:
    6    (I) UPON THE RECOMMENDATION OF A PHYSICIAN,  A  PELVIC  EXAM,  GENETIC
    7  TESTING,  ULTRASOUND  AND  BLOOD  TESTING AT ANY AGE FOR COVERED PERSONS
    8  HAVING A HIGH RISK OF DEVELOPING OVARIAN CANCER  OR  WHO  HAVE  A  FIRST
    9  DEGREE RELATIVE WITH A PRIOR HISTORY OF OVARIAN CANCER;
   10    (II) A SINGLE BASELINE ULTRASOUND FOR COVERED PERSONS AGED THIRTY-FIVE
   11  THROUGH THIRTY-NINE, INCLUSIVE; AND
   12    (III) AN ANNUAL ULTRASOUND FOR COVERED PERSONS AGED FORTY AND OLDER.
   13    (B)  SUCH COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS PARA-
   14  GRAPH MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND  COINSURANCE  AS  MAY  BE
   15  DEEMED  APPROPRIATE  BY  THE  SUPERINTENDENT  AND AS ARE CONSISTENT WITH
   16  THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.
   17    (C) (I) SUCH POLICY SHALL PROVIDE FOR ADDITIONAL COVERAGE FOR COMPUTED
   18  TOMOGRAPHY, BARIUM ENEMA X-RAYS, MAGNETIC RESONANCE IMAGING (MRI), POSI-
   19  TRON EMISSION TOMOGRAPHY,  LAPAROSCOPY,  COLONOSCOPY  AND  BIOPSY  IF  A
   20  PERSON  IS  BELIEVED  TO  BE AT INCREASED RISK FOR OVARIAN CANCER DUE TO
   21  FAMILY HISTORY OR PRIOR PERSONAL HISTORY  OF  OVARIAN  CANCER,  POSITIVE
   22  GENETIC  TESTING  OR  OTHER  INDICATIONS  AS DETERMINED BY SUCH PERSON'S
   23  PHYSICIAN OR NURSE PRACTITIONER.

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD06910-04-3
       S. 5373                             2

    1    (II) SUCH ADDITIONAL COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND
    2  COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE  SUPERINTENDENT  AND  AS
    3  ARE  CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN
    4  POLICY.
    5    S 2. Subsection (1) of section 3221 of the insurance law is amended by
    6  adding a new paragraph 11-b to read as follows:
    7    (11-B) (A) EVERY INSURER DELIVERING A GROUP OR BLANKET POLICY OR ISSU-
    8  ING  A  GROUP OR BLANKET POLICY FOR DELIVERY IN THIS STATE THAT PROVIDES
    9  COVERAGE FOR HOSPITAL,  SURGICAL  OR  MEDICAL  CARE  SHALL  PROVIDE  THE
   10  FOLLOWING COVERAGE FOR SCREENING FOR OVARIAN CANCER:
   11    (I)  UPON  THE  RECOMMENDATION  OF A PHYSICIAN, A PELVIC EXAM, GENETIC
   12  TESTING, ULTRASOUND AND BLOOD TESTING AT ANY  AGE  FOR  COVERED  PERSONS
   13  HAVING  A  HIGH  RISK  OF  DEVELOPING OVARIAN CANCER OR WHO HAVE A FIRST
   14  DEGREE RELATIVE WITH A PRIOR HISTORY OF OVARIAN CANCER;
   15    (II) A SINGLE BASELINE ULTRASOUND FOR COVERED PERSONS AGED THIRTY-FIVE
   16  THROUGH THIRTY-NINE, INCLUSIVE; AND
   17    (III) AN ANNUAL ULTRASOUND FOR COVERED PERSONS AGED FORTY AND OLDER.
   18    (B) SUCH COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS  PARA-
   19  GRAPH  MAY  BE  SUBJECT  TO ANNUAL DEDUCTIBLES AND COINSURANCE AS MAY BE
   20  DEEMED APPROPRIATE BY THE SUPERINTENDENT  AND  AS  ARE  CONSISTENT  WITH
   21  THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.
   22    (C) (I) SUCH POLICY SHALL PROVIDE FOR ADDITIONAL COVERAGE FOR COMPUTED
   23  TOMOGRAPHY, BARIUM ENEMA X-RAYS, MAGNETIC RESONANCE IMAGING (MRI), POSI-
   24  TRON  EMISSION  TOMOGRAPHY,  LAPAROSCOPY,  COLONOSCOPY  AND  BIOPSY IF A
   25  PERSON IS BELIEVED TO BE AT INCREASED RISK FOR  OVARIAN  CANCER  DUE  TO
   26  FAMILY  HISTORY  OR  PRIOR  PERSONAL HISTORY OF OVARIAN CANCER, POSITIVE
   27  GENETIC TESTING OR OTHER INDICATIONS  AS  DETERMINED  BY  SUCH  PERSON'S
   28  PHYSICIAN OR NURSE PRACTITIONER.
   29    (II) SUCH ADDITIONAL COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND
   30  COINSURANCE  AS  MAY  BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS
   31  ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A  GIVEN
   32  POLICY.
   33    S  3.  Section  4303  of  the insurance law is amended by adding a new
   34  subsection (p-1) to read as follows:
   35    (P-1) (1) A MEDICAL EXPENSE INDEMNITY CORPORATION, A HOSPITAL  SERVICE
   36  CORPORATION  OR  A HEALTH SERVICE CORPORATION THAT PROVIDES COVERAGE FOR
   37  HOSPITAL, SURGICAL OR MEDICAL CARE SHALL PROVIDE THE FOLLOWING  COVERAGE
   38  FOR SCREENING FOR OVARIAN CANCER:
   39    (A)  UPON  THE  RECOMMENDATION  OF A PHYSICIAN, A PELVIC EXAM, GENETIC
   40  TESTING, ULTRASOUND AND BLOOD TESTING AT ANY  AGE  FOR  COVERED  PERSONS
   41  HAVING  A  HIGH  RISK  OF  DEVELOPING OVARIAN CANCER OR WHO HAVE A FIRST
   42  DEGREE RELATIVE WITH A PRIOR HISTORY OF OVARIAN CANCER;
   43    (B) A SINGLE BASELINE ULTRASOUND FOR COVERED PERSONS AGED  THIRTY-FIVE
   44  THROUGH THIRTY-NINE, INCLUSIVE; AND
   45    (C) AN ANNUAL ULTRASOUND FOR COVERED PERSONS AGED FORTY AND OLDER.
   46    (2)  SUCH COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS PARA-
   47  GRAPH MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND  COINSURANCE  AS  MAY  BE
   48  DEEMED  APPROPRIATE  BY  THE  SUPERINTENDENT  AND AS ARE CONSISTENT WITH
   49  THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.
   50    (3) (A) SUCH POLICY SHALL PROVIDE FOR ADDITIONAL COVERAGE FOR COMPUTED
   51  TOMOGRAPHY, BARIUM ENEMA X-RAYS, MAGNETIC RESONANCE IMAGING (MRI), POSI-
   52  TRON EMISSION TOMOGRAPHY,  LAPAROSCOPY,  COLONOSCOPY  AND  BIOPSY  IF  A
   53  PERSON  IS  BELIEVED  TO  BE AT INCREASED RISK FOR OVARIAN CANCER DUE TO
   54  FAMILY HISTORY OR PRIOR PERSONAL HISTORY  OF  OVARIAN  CANCER,  POSITIVE
   55  GENETIC  TESTING  OR  OTHER  INDICATIONS  AS DETERMINED BY SUCH PERSON'S
   56  PHYSICIAN OR NURSE PRACTITIONER.
       S. 5373                             3

    1    (B) SUCH ADDITIONAL COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES  AND
    2  COINSURANCE  AS  MAY  BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS
    3  ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A  GIVEN
    4  POLICY.
    5    S  4.  This  act  shall take effect on the sixtieth day after it shall
    6  have become a law.
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