S T A T E O F N E W Y O R K
________________________________________________________________________
2380
2009-2010 Regular Sessions
I N S E N A T E
February 19, 2009
___________
Introduced by Sen. PADAVAN -- 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 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. Subsection (i) of section 3216 of the insurance law is
2 amended by adding a new paragraph 26 to read as follows:
3 (26) (A) EVERY POLICY WHICH PROVIDES COVERAGE PURSUANT TO THIS SECTION
4 SHALL PROVIDE COVERAGE TO ANY NAMED SUBSCRIBER OR OTHER PERSON COVERED
5 THEREUNDER FOR EXPENSES INCURRED IN CONDUCTING COLORECTAL CANCER EXAM-
6 INATIONS AND LABORATORY TESTS AT REGULAR INTERVALS, INCLUDING EXPENSES
7 INCURRED IN CONDUCTING PHYSICIAN CONSULTATIONS FOR COLORECTAL CANCER
8 PRIOR TO SUCH EXAMINATIONS AND TESTS, FOR PERSONS FIFTY YEARS OF AGE OR
9 OLDER AND FOR PERSONS OF ANY AGE WHO ARE CONSIDERED TO BE AT HIGH RISK
10 FOR COLORECTAL CANCER. THE METHODS OF SCREENING FOR WHICH BENEFITS SHALL
11 BE PROVIDED SHALL INCLUDE BUT NOT BE LIMITED TO:
12 (I) A SCREENING FECAL OCCULT BLOOD TEST;
13 (II) FLEXIBLE SIGMOIDOSCOPY;
14 (III) COLONOSCOPY;
15 (IV) BARIUM ENEMA; OR
16 (V) THE MOST RELIABLE, MEDICALLY RECOGNIZED SCREENING TEST AVAILABLE;
17 AND
18 (VI) ANY COMBINATION THEREOF.
19 THE METHOD AND FREQUENCY OF SCREENING TO BE UTILIZED SHALL BE IN
20 ACCORD WITH THE MOST RECENTLY PUBLISHED GUIDELINES OF THE AMERICAN
21 COLLEGE OF GASTROENTEROLOGY OR THE AMERICAN GASTROENTEROLOGICAL ASSOCI-
22 ATION IN CONSULTATION WITH THE AMERICAN CANCER SOCIETY.
23 (B) AS USED IN THIS PARAGRAPH, "HIGH RISK FOR COLORECTAL CANCER" SHALL
24 MEAN A PERSON HAS,
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02732-01-9
S. 2380 2
1 (I) A FAMILY HISTORY OF FAMILIAL ADENOMATOUS POLYPOSIS; HEREDITARY
2 NON-POLYPOSIS COLON CANCER; OR BREAST, OVARIAN, ENDOMETRIAL OR COLON
3 CANCER OR POLYPS;
4 (II) CHRONIC INFLAMMATORY BOWEL DISEASE; OR
5 (III) A BACKGROUND, ETHNICITY OR LIFESTYLE THAT THE PHYSICIAN BELIEVES
6 PUTS THE PERSON AT ELEVATED RISK FOR COLORECTAL CANCER.
7 S 2. Subsection (k) of section 3221 of the insurance law is amended by
8 adding a new paragraph 15 to read as follows:
9 (15) (A) EVERY POLICY WHICH PROVIDES COVERAGE PURSUANT TO THIS SECTION
10 SHALL PROVIDE COVERAGE TO ANY NAMED SUBSCRIBER OR OTHER PERSON COVERED
11 THEREUNDER FOR EXPENSES INCURRED IN CONDUCTING COLORECTAL CANCER EXAM-
12 INATIONS AND LABORATORY TESTS AT REGULAR INTERVALS, INCLUDING EXPENSES
13 INCURRED IN CONDUCTING PHYSICIAN CONSULTATIONS FOR COLORECTAL CANCER
14 PRIOR TO SUCH EXAMINATIONS AND TESTS, FOR PERSONS FIFTY YEARS OF AGE OR
15 OLDER AND FOR PERSONS OF ANY AGE WHO ARE CONSIDERED TO BE AT HIGH RISK
16 FOR COLORECTAL CANCER. THE METHODS OF SCREENING FOR WHICH BENEFITS SHALL
17 BE PROVIDED SHALL INCLUDE BUT NOT BE LIMITED TO:
18 (I) A SCREENING FECAL OCCULT BLOOD TEST;
19 (II) FLEXIBLE SIGMOIDOSCOPY;
20 (III) COLONOSCOPY;
21 (IV) BARIUM ENEMA; OR
22 (V) THE MOST RELIABLE, MEDICALLY RECOGNIZED SCREENING TEST AVAILABLE;
23 AND
24 (VI) ANY COMBINATION THEREOF.
25 THE METHOD AND FREQUENCY OF SCREENING TO BE UTILIZED SHALL BE IN
26 ACCORD WITH THE MOST RECENTLY PUBLISHED GUIDELINES OF THE AMERICAN
27 COLLEGE OF GASTROENTEROLOGY OR THE AMERICAN GASTROENTEROLOGICAL ASSOCI-
28 ATION IN CONSULTATION WITH THE AMERICAN CANCER SOCIETY.
29 (B) AS USED IN THIS PARAGRAPH, "HIGH RISK FOR COLORECTAL CANCER" SHALL
30 MEAN A PERSON HAS,
31 (I) A FAMILY HISTORY OF FAMILIAL ADENOMATOUS POLYPOSIS; HEREDITARY
32 NON-POLYPOSIS COLON CANCER; OR BREAST, OVARIAN, ENDOMETRIAL OR COLON
33 CANCER OR POLYPS;
34 (II) CHRONIC INFLAMMATORY BOWEL DISEASE; OR
35 (III) A BACKGROUND, ETHNICITY OR LIFESTYLE THAT THE PHYSICIAN BELIEVES
36 PUTS THE PERSON AT ELEVATED RISK FOR COLORECTAL CANCER.
37 S 3. Subsection (a) of section 4303 of the insurance law is amended by
38 adding a new paragraph 4 to read as follows:
39 (4) TO PERSONS FIFTY YEARS OF AGE OR OLDER FOR SERVICES RELATED TO THE
40 CONDUCTING OF COLORECTAL CANCER EXAMINATIONS AND LABORATORY TESTS AT
41 REGULAR INTERVALS, INCLUDING EXPENSES INCURRED IN CONDUCTING PHYSICIAN
42 CONSULTATIONS FOR COLORECTAL CANCER PRIOR TO SUCH EXAMINATIONS AND
43 TESTS, INCLUDING BUT NOT LIMITED TO, COLONOSCOPIES, COLOSCOPIES, SCREEN-
44 ING FECAL OCCULT BLOOD TESTS, FLEXIBLE SIGMOIDOSCOPIES OR BARIUM ENEMAS.
45 S 4. The superintendent of insurance shall require an insurer, health
46 carrier or health benefit plan to notify enrollees annually of colorec-
47 tal cancer screenings covered by such enrollees' health benefit plan and
48 the most recently published guidelines of the American College of
49 Gastroenterology or the American Gastroenterological Association in
50 consultation with the American Cancer Society for colorectal cancer
51 screenings or notify enrollees at intervals consistent with the most
52 recently published guidelines of the American College of Gastroenterolo-
53 gy or the American Gastroenterological Association in consultation with
54 the American Cancer Society of colorectal cancer screenings which are
55 covered by such enrollees' health benefit plans. The notice shall be
56 delivered by mail unless the enrollee and health carrier have agreed on
S. 2380 3
1 another method of notification. The superintendent of insurance is
2 authorized to promulgate necessary rules and regulations for the
3 purposes of providing such notification.
4 S 5. This act shall take effect immediately and shall apply to any
5 policy issued, delivered, renewed, and/or modified on or after the
6 effective date of this act.