Bill Text: NY S00639 | 2013-2014 | General Assembly | Introduced
Bill Title: Removes cancer screening deductibles, copayments and coinsurance.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2014-01-08 - REFERRED TO INSURANCE [S00639 Detail]
Download: New_York-2013-S00639-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
639
2013-2014 Regular Sessions
I N S E N A T E
(PREFILED)
January 9, 2013
___________
Introduced by Sen. STAVISKY -- 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 cancer screening
deductibles and copayments
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Subparagraph (B) of paragraph 11 and subparagraph (C) of
2 paragraph 15 of subsection (i) of section 3216 of the insurance law, as
3 amended by chapter 219 of the laws of 2011, are amended to read as
4 follows:
5 (B) Such coverage required pursuant to subparagraph (A) or (C) of this
6 paragraph [may] SHALL NOT be subject to annual deductibles and coinsu-
7 rance [as may be deemed appropriate by the superintendent and as are
8 consistent with those established for other benefits within a given
9 policy].
10 (C) Such coverage required pursuant to subparagraph (A) or (B) of this
11 paragraph [may] SHALL NOT be subject to annual deductibles and coinsu-
12 rance [as may be deemed appropriate by the superintendent and as are
13 consistent with those established for other benefits within a given
14 policy].
15 S 2. Subparagraph (B) of paragraph 11 and subparagraph (C) of para-
16 graph 14 of subsection (1) of section 3221 of the insurance law, as
17 amended by chapter 219 of the laws of 2011, are amended to read as
18 follows:
19 (B) Such coverage required pursuant to subparagraph (A) or (C) of this
20 paragraph [may] SHALL NOT be subject to annual deductibles and coinsu-
21 rance [as may be deemed appropriate by the superintendent and as are
22 consistent with those established for other benefits within a given
23 policy].
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03550-01-3
S. 639 2
1 (C) Such coverage required pursuant to subparagraph (A) or (B) of this
2 paragraph [may] SHALL NOT be subject to annual deductibles and coinsu-
3 rance [as may be deemed appropriate by the superintendent and as are
4 consistent with those established for other benefits within a given
5 policy].
6 S 3. Subparagraph (D) of paragraph 1 of subsection (p) and paragraph 1
7 of subsection (t) of section 4303 of the insurance law, as amended by
8 chapter 219 of the laws of 2011, are amended to read as follows:
9 (D) The coverage required in this paragraph or paragraph two of this
10 subsection [may] SHALL NOT be subject to annual deductibles and coinsu-
11 rance [as may be deemed appropriate by the superintendent and as are
12 consistent with those established for other benefits within a given
13 contract].
14 (1) A medical expense indemnity corporation, a hospital service corpo-
15 ration or a health service corporation that provides coverage for hospi-
16 tal, surgical, or medical care shall provide coverage for an annual
17 cervical cytology screening for cervical cancer and its precursor states
18 for women aged eighteen and older. Such coverage required by this para-
19 graph [may] SHALL NOT be subject to annual deductibles and coinsurance
20 [as may be deemed appropriate by the superintendent and as are consist-
21 ent with those established for other benefits within a given contract].
22 S 4. Subsection (c) of section 4321 of the insurance law, as amended
23 by chapter 219 of the laws of 2011, is amended to read as follows:
24 (c) The health maintenance organization shall impose a fifteen dollar
25 copayment on all visits to a physician or other provider with the excep-
26 tion of visits for pre-natal and post-natal care, well child visits
27 provided pursuant to paragraph two of subsection (j), MAMMOGRAPHY
28 SCREENING PROVIDED PURSUANT TO SUBSECTION (P), AND CERVICAL CYTOLOGY
29 SCREENING PROVIDED PURSUANT TO SUBSECTION (T) of section four thousand
30 three hundred three of this article, preventive health services provided
31 pursuant to subparagraph (F) of paragraph four of subsection (b) of
32 section four thousand three hundred twenty-two of this article, or items
33 or services for bone mineral density provided pursuant to subparagraph
34 (D) of paragraph twenty-six of subsection (b) of section four thousand
35 three hundred twenty-two of this article for which no copayment shall
36 apply. A copayment of fifteen dollars shall be imposed on equipment,
37 supplies and self-management education for the treatment of diabetes. A
38 fifty dollar copayment shall be imposed on emergency services rendered
39 in the emergency room of a hospital; however, this copayment must be
40 waived if hospital admission results. Surgical services shall be subject
41 to a copayment of the lesser of twenty percent of the cost of such
42 services or two hundred dollars per occurrence. A five hundred dollar
43 copayment shall be imposed on inpatient hospital services per continuous
44 hospital confinement. Ambulatory surgical services shall be subject to a
45 facility copayment charge of seventy-five dollars. Coinsurance of ten
46 percent shall apply to visits for the diagnosis and treatment of mental,
47 nervous or emotional disorders or ailments.
48 S 5. Subsections (c) and (d) of section 4322 of the insurance law, as
49 amended by chapter 219 of the laws of 2011, are amended to read as
50 follows:
51 (c) The in-plan benefit system shall impose a ten dollar copayment on
52 all visits to a physician or other provider with the exception of visits
53 for pre-natal and post-natal care, well child visits provided pursuant
54 to paragraph two of subsection (j), MAMMOGRAPHY SCREENING PROVIDED
55 PURSUANT TO SUBSECTION (P), AND CERVICAL CYTOLOGY SCREENING PROVIDED
56 PURSUANT TO SUBSECTION (T) of section four thousand three hundred three
S. 639 3
1 of this article, preventive health services provided pursuant to subpar-
2 agraph (F) of paragraph four of subsection (b) of this section or items
3 or services for bone mineral density provided pursuant to subparagraph
4 (D) of paragraph twenty-six of subsection (b) of this section for which
5 no copayment shall apply. A copayment of ten dollars shall be imposed on
6 equipment, supplies and self-management education for the treatment of
7 diabetes. Coinsurance of ten percent shall apply to visits for the diag-
8 nosis and treatment of mental, nervous or emotional disorders or
9 ailments. A thirty-five dollar copayment shall be imposed on emergency
10 services rendered in the emergency room of a hospital; however, this
11 copayment must be waived if hospital admission results.
12 (d) The out-of-plan benefit system shall have an annual deductible
13 established at one thousand dollars per calendar year for an individual
14 and two thousand dollars per year for a family. Coinsurance shall be
15 established at twenty percent with the health maintenance organization
16 or insurer paying eighty percent of the usual, customary and reasonable
17 charges, or eighty percent of the amounts listed on a fee schedule filed
18 with and approved by the superintendent which provides a comparable
19 level of reimbursement. Coinsurance of ten percent shall apply to outpa-
20 tient visits for the diagnosis and treatment of mental, nervous or
21 emotional disorders or ailments. The benefits described in subparagraph
22 (F) of paragraph three, SUBPARAGRAPHS (D) AND (E) OF PARAGRAPH FOUR and
23 paragraphs seventeen and eighteen of subsection (b) of this section
24 shall not be subject to the deductible or coinsurance. The benefits
25 described in paragraph nine of subsection (b) of this section shall not
26 be subject to the deductible. The out-of-plan out-of-pocket maximum
27 deductible and coinsurance shall be established at three thousand
28 dollars per calendar year for an individual and five thousand dollars
29 per calendar year for a family. The out-of-plan lifetime benefit maximum
30 shall be established at five hundred thousand dollars for benefits that
31 are not essential health benefits. A lifetime limit on the dollar amount
32 of essential health benefits for any individual shall not be estab-
33 lished. For purposes of this subsection, "essential health benefits"
34 shall have the meaning ascribed by section 1302(b) of the Affordable
35 Care Act, 42 U.S.C. S 18022(b).
36 S 6. This act shall take effect immediately and the provisions of this
37 act shall apply to policies and contracts issued, renewed, modified,
38 altered or amended on or after such effective date.
