Requires insurance coverage of sonograms and other diagnostic procedures used to detect breast cancer for covered persons with a prior history of breast cancer or who have a first degree relative with a prior history of breast cancer.
STATE OF NEW YORK
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7921--A
IN SENATE
January 3, 2024
___________
Introduced by Sen. RHOADS -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
AN ACT to amend the insurance law, in relation to coverage of certain
procedures to detect 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 (l) of
2 section 3221 of the insurance law, as amended by chapter 143 of the laws
3 of 2019, is amended to read as follows:
4 (A) Every insurer delivering a group or blanket policy or issuing a
5 group or blanket policy for delivery in this state that provides cover-
6 age for hospital, surgical or medical care shall provide the following
7 coverage for mammography 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 through thirty-
14 nine, inclusive]; and
15 (iii) [an annual mammogram, which may be provided by breast tomosyn-
16 thesis, for covered persons aged forty and older; and
17 (iv)] for large group policies that provide coverage for hospital,
18 surgical or medical care, [an annual mammogram] mammograms for covered
19 persons [aged thirty-five through thirty-nine, inclusive] having a prior
20 history of breast cancer or who have a first degree relative with a
21 prior history of breast cancer, or any sonogram or other diagnostic
22 procedure used to detect breast cancer, upon the recommendation of a
23 physician, subject to the insurer's determination that the mammogram is
24 medically necessary.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11825-03-4
S. 7921--A 2
1 § 2. Subparagraph (D) of paragraph 1 of subsection (p) of section 4303
2 of the insurance law, as amended by chapter 143 of the laws of 2019, is
3 amended to read as follows:
4 (D) for large group contracts offered by a medical expense indemnity
5 corporation, a hospital service corporation or a health service corpo-
6 ration that provide coverage for hospital, surgical or medical care, [an
7 annual mammogram] mammograms for covered persons [aged thirty-five
8 through thirty-nine, inclusive] having a prior history of breast cancer
9 or who have a first degree relative with a prior history of breast
10 cancer, or any sonogram or other diagnostic procedure used to detect
11 breast cancer, upon the recommendation of a physician, subject to the
12 corporation's determination that the mammogram is medically necessary;
13 and
14 § 3. This act shall take effect on the thirtieth day after it shall
15 have become a law, and shall apply to policies and contracts issued,
16 renewed, modified, altered or amended on or after such effective date.
