Requires certain providers of health care policies to provide coverage for colorectal cancer early detection in accordance with the American cancer society guidelines; requires the insurance carriers to notify enrollees of such coverage and screening guidelines via mail.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A2085A
SPONSOR: Dinowitz TITLE OF BILL:
An act to amend the insurance law, in relation to providing insurance
coverage for colorectal cancer early detection
PURPOSE:
This bill would require health insurance providers to provide coverage
for colorectal cancer screening(s) in accordance with the American
Cancer Society guidelines for average risk individuals. As of May 2021,
the guidelines recommend beginning screening at age 45 for such individ-
uals.
SUMMARY OF PROVISIONS:
Section one renumbers paragraph 27 of subsection (i) of section 3216 of
the insurance law, as added by chapter 457 of the laws of 2010, to make
it paragraph 36; renumbers paragraph 28 of subsection (i) of section
3216 of the insurance law, as amended by chapter 11 of the laws of 2012,
to make it paragraph 37; and renumbers paragraph 34 of subsection (i) of
section 3216 of the insurance law as added by section 10 part MM of
chapter 57 of the laws of 2018, to make it paragraph 38.
Section one also amends section 3216 of the insurance law to add a new
paragraph 11-b to require every policy issued for delivery in this state
to provide coverage for colorectal cancer screening(s) in accordance
with the American Cancer Society guidelines for average risk individuals
(age 45 as of May 2021). Such coverage shall include all preventative
screening lab tests and follow-up colonoscopy procedures without
subjecting individuals to deductibles, co-insurance or cost sharing
requirements.
Section two makes the same substantive change as section one to add a
new paragraph 11-b to section 3221 of the insurance law.
Section three would require the superintendent of financial services to
require health insurance providers to annually notify enrollees of colo-
rectal screenings covered by such enrollees' plan and the most recently
published guidelines.
Section four is the effective date.
JUSTIFICATION:
Colon cancer is the second leading cancer killer in America and is the
primary cancer killer among nonsmokers. Without preventative action, one
in every 17 Americans will be diagnosed with colon cancer. However, with
colonoscopy screening, that risk is reduced to as low as one in 100
people.
Studies have found that a colonoscopy can detect cancer in patients
without symptoms that would be missed by other screening methods. By
requiring coverage for preventative screenings, this deadly cancer can
be detected earlier, making treatment more likely to be successful.
PRIOR LEGISLATIVE HISTORY:
2019-20 - A.2883 - Referred to insurance
FISCAL IMPLICATIONS:
Undetermined.
EFFECTIVE DATE:
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.
STATE OF NEW YORK
________________________________________________________________________
2085--A
2021-2022 Regular Sessions
IN ASSEMBLY
January 14, 2021
___________
Introduced by M. of A. DINOWITZ, GALEF, CUSICK, CYMBROWITZ, ZEBROWSKI,
ENGLEBRIGHT, ROZIC -- Multi-Sponsored by -- M. of A. BARNWELL, CAHILL,
COLTON, COOK, GLICK, GOTTFRIED -- read once and referred 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 providing insurance
coverage for colorectal cancer early detection
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph 27 of subsection (i) of section 3216 of the
2 insurance law, as added by chapter 457 of the laws of 2010, is renum-
3 bered paragraph 36, paragraph 28 of subsection (i) of section 3216 of
4 the insurance law, as amended by chapter 11 of the laws of 2012, is
5 renumbered paragraph 37, paragraph 34 of subsection (i) of section 3216
6 of the insurance law, as added by section 10 of part MM of chapter 57 of
7 the laws of 2018, is renumbered paragraph 38 and a new paragraph 11-b is
8 added to read as follows:
9 (11-b) (A) Every policy delivered or issued for delivery in this state
10 which provides medical coverage that includes coverage for physician
11 services in a physician's office and every policy which provides major
12 medical or similar comprehensive-type coverage shall provide, upon the
13 prescription of a health care provider legally authorized to prescribe
14 under title eight of the education law, coverage for colorectal cancer
15 screening. The coverage required by this paragraph shall include preven-
16 tive colorectal cancer screening coverage for all colorectal cancer
17 examinations and laboratory tests in accordance with American Cancer
18 Society Guidelines for colorectal cancer screening of average risk indi-
19 viduals, including an initial colonoscopy or other medical test or
20 procedure for colorectal cancer screening and a follow-up colonoscopy
21 performed as a result of a positive result on a non-colonoscopy preven-
22 tive screening test.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD05478-04-1
A. 2085--A 2
1 (B) An individual shall not be subject to a deductible, coinsurance,
2 or any other cost-sharing requirements for services consistent with
3 subparagraph (A) of this paragraph received from participating provid-
4 ers.
5 § 2. Subsection (l) 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 policy delivered or issued for delivery in this state
8 which provides medical coverage that includes coverage for physician
9 services in a physician's office and every policy which provides major
10 medical or similar comprehensive-type coverage shall provide, upon the
11 prescription of a health care provider legally authorized to prescribe
12 under title eight of the education law, coverage for colorectal cancer
13 screening. The coverage required by this paragraph shall include
14 preventive colorectal cancer screening coverage for all colorectal
15 cancer examinations and laboratory tests in accordance with American
16 Cancer Society Guidelines for colorectal cancer screening of average
17 risk individuals, including an initial colonoscopy or other medical test
18 or procedure for colorectal cancer screening and a follow-up colonoscopy
19 performed as a result of a positive result on a non-colonoscopy preven-
20 tive screening test.
21 (B) An individual shall not be subject to a deductible, coinsurance,
22 or any other cost-sharing requirements for services consistent with
23 subparagraph (A) of this paragraph received from participating provid-
24 ers.
25 § 3. The superintendent of financial services shall require an insur-
26 er, health carrier or health benefit plan to notify enrollees annually
27 of colorectal cancer screenings covered by such enrollees' health bene-
28 fit plan and the most recently published guidelines of the American
29 College of Gastroenterology or the American Gastroenterological Associ-
30 ation in consultation with the American Cancer Society for colorectal
31 cancer screenings or notify enrollees at intervals consistent with the
32 most recently published guidelines of the American College of Gastroen-
33 terology or the American Gastroenterological Association in consultation
34 with the American Cancer Society of colorectal cancer screenings which
35 are covered by such enrollees' health benefit plans. The notice shall
36 be delivered by mail unless the enrollee and health carrier have agreed
37 on another method of notification. The superintendent of financial
38 services is authorized to promulgate necessary rules and regulations for
39 the purposes of providing such notification.
40 § 4. This act shall take effect immediately and shall apply to any
41 policy issued, delivered, renewed, and/or modified on or after the
42 effective date of this act.
