Bill Text: NY S07964 | 2023-2024 | General Assembly | Introduced
Bill Title: Relates to coverage for the detection of breast cancer; lowers the age of eligibility for an annual mammogram from 40 to 30 years old; requires coverage for follow-up treatment including biopsies.
Spectrum: Slight Partisan Bill (Democrat 2-1)
Status: (Introduced) 2024-01-04 - REFERRED TO INSURANCE [S07964 Detail]
Download: New_York-2023-S07964-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 7964 IN SENATE January 4, 2024 ___________ Introduced by Sens. PARKER, PALUMBO -- 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 143 of the laws of 25 2019, is amended and a new subparagraph (G) is added to read as follows: 26 (A) Every insurer delivering a group or blanket policy or issuing a 27 group or blanket policy for delivery in this state that provides cover- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD05997-01-3S. 7964 2 1 age for hospital, surgical or medical care shall provide the following 2 coverage for mammography screening for occult breast cancer: 3 (i) upon the recommendation of a physician, a mammogram, which may be 4 provided by breast tomosynthesis, at any age for covered persons having 5 a prior history of breast cancer or who have a first degree relative 6 with a prior history of breast cancer; 7 (ii) a single baseline mammogram, which may be provided by breast 8 tomosynthesis, for covered persons aged [thirty-five] twenty-five 9 through [thirty-nine] twenty-nine, inclusive; 10 (iii) an annual mammogram, which may be provided by breast tomosynthe- 11 sis, for covered persons aged [forty] thirty and older; and 12 (iv) for large group policies that provide coverage for hospital, 13 surgical or medical care, an annual mammogram for covered persons aged 14 [thirty-five] twenty-five through [thirty-nine] twenty-nine, inclusive, 15 upon the recommendation of a physician, subject to the insurer's deter- 16 mination that the mammogram is medically necessary. 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 § 3. Subparagraphs (B), (C) and (D) of paragraph 1 of subsection (p) 24 of section 4303 of the insurance law, as amended by chapter 143 of the 25 laws of 2019, are amended and a new paragraph 6 is added to read as 26 follows: 27 (B) a single baseline mammogram, which may be provided by breast tomo- 28 synthesis, for covered persons aged [thirty-five] twenty-five through 29 [thirty-nine] twenty-nine, inclusive; 30 (C) an annual mammogram, which may be provided by breast tomosythesis, 31 for covered persons aged [forty] thirty and older; 32 (D) for large group contracts offered by a medical expense indemnity 33 corporation, a hospital service corporation or a health service corpo- 34 ration that provide coverage for hospital, surgical or medical care, an 35 annual mammogram for covered persons aged [thirty-five] twenty-five 36 through [thirty-nine] twenty-nine, inclusive, upon the recommendation of 37 a physician, subject to the corporation's determination that the mammo- 38 gram is medically necessary; and 39 (6) Coverage shall also be provided, upon the recommendation of a 40 physician, for follow-up diagnostic testing for the detection of breast 41 cancer, including breast biopsies, in the event that a physician deter- 42 mines that a covered person has had an abnormal mammogram. Such follow- 43 up diagnostic testing shall not be subject to annual deductibles or 44 coinsurance. 45 § 4. This act shall take effect on the ninetieth day after it shall 46 have become a law and shall apply to all policies and contracts issued, 47 renewed, modified, altered or amended on or after such date.
