STATE OF NEW YORK
________________________________________________________________________
2596
2019-2020 Regular Sessions
IN SENATE
January 28, 2019
___________
Introduced by Sen. PARKER -- 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 coverage for the
detection of breast cancer
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subparagraph (A) of paragraph 11 of subsection (i) of
2 section 3216 of the insurance law, as amended by chapter 414 of the laws
3 of 2017, is amended and a new subparagraph (G) is added to read as
4 follows:
5 (A) Every policy that provides coverage for hospital, surgical or
6 medical care shall provide the following coverage for mammography
7 screening for occult breast cancer:
8 (i) upon the recommendation of a physician, a mammogram, which may be
9 provided by breast tomosynthesis, at any age for covered persons having
10 a prior history of breast cancer or who have a first degree relative
11 with a prior history of breast cancer;
12 (ii) a single baseline mammogram, which may be provided by breast
13 tomosynthesis, for covered persons aged [thirty-five] twenty-five
14 through [thirty-nine] twenty-nine, inclusive; and
15 (iii) an annual mammogram, which may be provided by breast tomosynthe-
16 sis, for covered persons aged [forty] thirty and older.
17 (G) Coverage shall also be provided, upon the recommendation of a
18 physician, for follow-up diagnostic testing for the detection of breast
19 cancer, including breast biopsies, in the event that a physician deter-
20 mines that a covered person has had an abnormal mammogram. Such follow-
21 up diagnostic testing shall not be subject to annual deductibles or
22 coinsurance.
23 § 2. Subparagraph (A) of paragraph 11 of subsection (l) of section
24 3221 of the insurance law, as amended by chapter 414 of the laws of
25 2017, is amended and a new subparagraph (G) is added to read as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD08326-01-9
S. 2596 2
1 (A) Every insurer delivering a group or blanket policy or issuing a
2 group or blanket policy for delivery in this state that provides cover-
3 age for hospital, surgical or medical care shall provide the following
4 coverage for mammography screening for occult breast cancer:
5 (i) upon the recommendation of a physician, a mammogram, which may be
6 provided by breast tomosynthesis, at any age for covered persons having
7 a prior history of breast cancer or who have a first degree relative
8 with a prior history of breast cancer;
9 (ii) a single baseline mammogram, which may be provided by breast
10 tomosynthesis, for covered persons aged [thirty-five] twenty-five
11 through [thirty-nine] twenty-nine, inclusive; and
12 (iii) an annual mammogram, which may be provided by breast tomosynthe-
13 sis, for covered persons aged [forty] thirty and older.
14 (G) Coverage shall also be provided, upon the recommendation of a
15 physician, for follow-up diagnostic testing for the detection of breast
16 cancer, including breast biopsies, in the event that a physician deter-
17 mines that a covered person has had an abnormal mammogram. Such follow-
18 up diagnostic testing shall not be subject to annual deductibles or
19 coinsurance.
20 § 3. Paragraph 1 of subsection (p) of section 4303 of the insurance
21 law, as amended by chapter 219 of the laws of 2011, subparagraphs (A),
22 (B) and (C) as amended by chapter 414 of the laws of 2017 and subpara-
23 graph (D) as amended by chapter 74 of the laws of 2016, is amended and a
24 new paragraph 6 is added to read as follows:
25 (1) A medical expense indemnity corporation, a hospital service corpo-
26 ration or a health service corporation that provides coverage for hospi-
27 tal, surgical or medical care shall provide the following coverage for
28 mammography screening for occult breast cancer:
29 (A) upon the recommendation of a physician, a mammogram, which may be
30 provided by breast tomosynthesis, at any age for covered persons having
31 a prior history of breast cancer or who have a first degree relative
32 with a prior history of breast cancer;
33 (B) a single baseline mammogram, which may be provided by breast tomo-
34 synthesis, for covered persons aged [thirty-five] twenty-five through
35 [thirty-nine] twenty-nine, inclusive; and
36 (C) an annual mammogram, which may be provided by breast tomosythesis,
37 for covered persons aged [forty] thirty and older.
38 (D) The coverage required in this paragraph or paragraph two of this
39 subsection shall not be subject to annual deductibles or coinsurance.
40 (6) Coverage shall also be provided, upon the recommendation of a
41 physician, for follow-up diagnostic testing for the detection of breast
42 cancer, including breast biopsies, in the event that a physician deter-
43 mines that a covered person has had an abnormal mammogram. Such follow-
44 up diagnostic testing shall not be subject to annual deductibles or
45 coinsurance.
46 § 4. This act shall take effect on the ninetieth day after it shall
47 have become a law and shall apply to all policies and contracts issued,
48 renewed, modified, altered or amended on or after such date.
