S T A T E O F N E W Y O R K ________________________________________________________________________ 4238 2013-2014 Regular Sessions I N A S S E M B L Y February 1, 2013 ___________ Introduced by M. of A. PRETLOW, JAFFEE -- Multi-Sponsored by -- M. of A. CAHILL, CLARK, COOK, CUSICK, DINOWITZ, GALEF, GLICK, HOOPER, JACOBS, V. LOPEZ, MAGEE, MILLMAN, ORTIZ, PERRY, SCARBOROUGH, SWEENEY, WEIN- STEIN, WEISENBERG, WRIGHT -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to health insurance coverage for diagnostic testing for ovarian cancer 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 DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE 4 WHICH PROVIDES MEDICAL COVERAGE THAT INCLUDES COVERAGE FOR PHYSICIAN 5 SERVICES IN A PHYSICIAN'S OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR 6 MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE, UPON THE 7 PRESCRIPTION OF A HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE 8 UNDER TITLE EIGHT OF THE EDUCATION LAW, COVERAGE FOR DIAGNOSTIC TESTING 9 FOR OVARIAN CANCER, INCLUDING A PELVIC EXAMINATION, A SONOGRAM, A CA 125 10 BLOOD TEST AND LABORATORY AND DIAGNOSTIC SERVICES PROVIDED IN CONNECTION 11 WITH EXAMINING AND EVALUATING SUCH BLOOD TEST FOR WOMEN AGED FORTY AND 12 OVER WITH ONE OR MORE FEMALE RELATIVES WITH A PRIOR HISTORY OF OVARIAN 13 CANCER. 14 (B) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE 15 AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT 16 WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY. 17 S 2. Subsection (l) of section 3221 of the insurance law is amended by 18 adding a new paragraph 11-b to read as follows: 19 (11-B) (A) EVERY INSURER WHICH DELIVERS OR ISSUES FOR DELIVERY IN THIS 20 STATE A POLICY WHICH PROVIDES MEDICAL COVERAGE THAT INCLUDES COVERAGE 21 FOR PHYSICIAN SERVICES IN A PHYSICIAN'S OFFICE OR MAJOR MEDICAL OR SIMI- 22 LAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE, UPON THE PRESCRIPTION OF EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD07577-01-3 A. 4238 2 1 A HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT 2 OF THE EDUCATION LAW, COVERAGE FOR DIAGNOSTIC TESTING FOR OVARIAN 3 CANCER, INCLUDING A PELVIC EXAMINATION, A SONOGRAM, A CA 125 BLOOD TEST 4 AND LABORATORY AND DIAGNOSTIC SERVICES PROVIDED IN CONNECTION WITH EXAM- 5 INING AND EVALUATING SUCH BLOOD TEST FOR WOMEN AGED FORTY AND OVER WITH 6 ONE OR MORE FEMALE RELATIVES WITH A PRIOR HISTORY OF OVARIAN CANCER. 7 (B) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE 8 AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT 9 WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY. 10 S 3. Section 4303 of the insurance law is amended by adding a new 11 subsection (jj) to read as follows: 12 (JJ) (1) A HOSPITAL SERVICE CORPORATION, MEDICAL EXPENSE INDEMNITY 13 CORPORATION OR HEALTH SERVICE CORPORATION WHICH PROVIDES MEDICAL COVER- 14 AGE THAT INCLUDES COVERAGE FOR PHYSICIAN SERVICES IN A PHYSICIAN'S 15 OFFICE OR MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL 16 PROVIDE, UPON THE PRESCRIPTION OF A HEALTH CARE PROVIDER LEGALLY AUTHOR- 17 IZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW, COVERAGE FOR 18 DIAGNOSTIC TESTING FOR OVARIAN CANCER, INCLUDING A PELVIC EXAMINATION, A 19 SONOGRAM, A CA 125 BLOOD TEST AND LABORATORY AND DIAGNOSTIC SERVICES 20 PROVIDED IN CONNECTION WITH EXAMINING AND EVALUATING SUCH BLOOD TEST FOR 21 WOMEN AGED FORTY AND OVER WITH ONE OR MORE FEMALE RELATIVES WITH A PRIOR 22 HISTORY OF OVARIAN CANCER. 23 (2) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE 24 AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT 25 WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY. 26 S 4. This act shall take effect on the first of January next succeed- 27 ing the date on which it shall have become a law and shall apply to all 28 policies issued, renewed, altered or modified on or after such effective 29 date.