S T A T E O F N E W Y O R K
________________________________________________________________________
4378--A
2011-2012 Regular Sessions
I N A S S E M B L Y
February 3, 2011
___________
Introduced by M. of A. ROSENTHAL, CAMARA, SPANO, GIBSON, GUNTHER,
BOYLAND, GOTTFRIED, MILLMAN, COLTON, CASTRO, MAISEL, HOOPER -- Multi-
Sponsored by -- M. of A. CAHILL, COOK, CRESPO, GIGLIO, GLICK,
JEFFRIES, MARKEY, McENENY, SCARBOROUGH, WEINSTEIN, WEISENBERG -- 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, the public health law and the execu-
tive 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,
3 subparagraph (B) of paragraph 11 as added by chapter 417 of the laws of
4 1989 and subparagraph (C) of paragraph 15 as amended by chapter 43 of
5 the laws of 1993, are amended to read as follows:
6 (B) Such coverage [may] SHALL NOT be subject to annual deductibles and
7 coinsurance [as may be deemed appropriate by the superintendent and as
8 are consistent with those established for other benefits within a given
9 policy].
10 (C) Such coverage [may] SHALL NOT be subject to annual deductibles and
11 coinsurance [as may be deemed appropriate by the superintendent and as
12 are consistent with those established for other benefits within a given
13 policy].
14 S 2. Subsection (i) of section 3216 of the insurance law is amended by
15 adding a new paragraph 28 to read as follows:
16 (28) NO POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE WHICH
17 PROVIDES COVERAGE FOR SCREENING FOR COLON CANCER SHALL IMPOSE ANY COST-
18 SHARING, DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS.
19 S 3. Subparagraph (B) of paragraph 11 and subparagraph (C) of para-
20 graph 14 of subsection (1) of section 3221 of the insurance law, as
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01826-03-1
A. 4378--A 2
1 amended by chapter 554 of the laws of 2002, are amended to read as
2 follows:
3 (B) Such coverage [may] SHALL NOT be subject to annual deductibles and
4 coinsurance [as may be deemed appropriate by the superintendent and as
5 are consistent with those established for other benefits within a given
6 policy].
7 (C) Such coverage [may] SHALL NOT be subject to annual deductibles and
8 coinsurance [as may be deemed appropriate by the superintendent and as
9 are consistent with those established for other benefits within a given
10 policy].
11 S 4. Subsection (a) of section 3221 of the insurance law is amended by
12 adding a new paragraph 17 to read as follows:
13 (17) NO POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE WHICH
14 PROVIDES COVERAGE FOR SCREENING FOR COLON CANCER SHALL IMPOSE ANY COST-
15 SHARING, DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS.
16 S 5. The closing paragraph of paragraph 1 of subsection (p) and para-
17 graph 1 of subsection (t) of section 4303 of the insurance law, as
18 amended by chapter 554 of the laws of 2002, are amended to read as
19 follows:
20 The coverage required in this paragraph [may] SHALL NOT be subject to
21 annual deductibles and coinsurance [as may be deemed appropriate by the
22 superintendent and as are consistent with those established for other
23 benefits within a given policy].
24 (1) A medical expense indemnity corporation, a hospital service corpo-
25 ration or a health service corporation which provides coverage for
26 hospital, surgical, or medical care shall provide coverage for an annual
27 cervical cytology screening for cervical cancer and its precursor states
28 for women aged eighteen and older. Such coverage [may] SHALL NOT be
29 subject to annual deductibles and coinsurance [as may be deemed appro-
30 priate by the superintendent and as are consistent with those estab-
31 lished for other benefits within a given contract].
32 S 6. Section 4303 of the insurance law is amended by adding a new
33 subsection (hh) to read as follows:
34 (HH) NO MEDICAL EXPENSE INDEMNITY CORPORATION, A HOSPITAL SERVICE
35 CORPORATION OR A HEALTH SERVICE CORPORATION WHICH PROVIDES COVERAGE FOR
36 SCREENING FOR COLON CANCER SHALL IMPOSE ANY COST-SHARING, DEDUCTIBLES OR
37 CO-INSURANCE OBLIGATIONS.
38 S 7. Subsection (c) of section 4321 of the insurance law, as added by
39 chapter 504 of the laws of 1995, is amended to read as follows:
40 (c) The health maintenance organization shall impose a fifteen dollar
41 copayment on all visits to a physician or other provider with the excep-
42 tion of visits for pre-natal and post-natal care or well child visits
43 provided pursuant to paragraph two of subsection (j), MAMMOGRAPHY
44 SCREENING PROVIDED PURSUANT TO SUBSECTION (P), AND CERVICAL CYTOLOGY
45 SCREENING PROVIDED PURSUANT TO SUBSECTION (T) of section four thousand
46 three hundred three of this article for which no copayment shall apply.
47 A copayment of fifteen dollars shall be imposed on equipment, supplies
48 and self-management education for the treatment of diabetes. A fifty
49 dollar copayment shall be imposed on emergency services rendered in the
50 emergency room of a hospital; however, this copayment must be waived if
51 hospital admission results. Surgical services shall be subject to a
52 copayment of the lesser of twenty percent of the cost of such services
53 or two hundred dollars per occurrence. A five hundred dollar copayment
54 shall be imposed on inpatient hospital services per continuous hospital
55 confinement. Ambulatory surgical services shall be subject to a facility
56 copayment charge of seventy-five dollars. Coinsurance of ten percent
A. 4378--A 3
1 shall apply to visits for the diagnosis and treatment of mental, nervous
2 or emotional disorders or ailments.
3 S 8. Subsections (c) and (d) of section 4322 of the insurance law, as
4 added by chapter 504 of the laws of 1995, are amended to read as
5 follows:
6 (c) The in-plan benefit system shall impose a ten dollar copayment on
7 all visits to a physician or other provider with the exception of visits
8 for pre-natal and post-natal care or well child visits provided pursuant
9 to paragraph two of subsection (j), MAMMOGRAPHY SCREENING PROVIDED
10 PURSUANT TO SUBSECTION (P), AND CERVICAL CYTOLOGY SCREENING PROVIDED
11 PURSUANT TO SUBSECTION (T) of section four thousand three hundred three
12 of this article for which no copayment shall apply. A copayment of ten
13 dollars shall be imposed on equipment, supplies and self-management
14 education for the treatment of diabetes. Coinsurance of ten percent
15 shall apply to visits for the diagnosis and treatment of mental, nervous
16 or emotional disorders or ailments. A thirty-five dollar copayment shall
17 be imposed on emergency services rendered in the emergency room of a
18 hospital; however, this copayment must be waived if hospital admission
19 results.
20 (d) The out-of-plan benefit system shall have an annual deductible
21 established at one thousand dollars per calendar year for an individual
22 and two thousand dollars per year for a family. Coinsurance shall be
23 established at twenty percent with the health maintenance organization
24 or insurer paying eighty percent of the usual, customary and reasonable
25 charges, or eighty percent of the amounts listed on a fee schedule filed
26 with and approved by the superintendent which provides a comparable
27 level of reimbursement. Coinsurance of ten percent shall apply to outpa-
28 tient visits for the diagnosis and treatment of mental, nervous or
29 emotional disorders or ailments. The benefits described in subparagraph
30 (F) of paragraph three, SUBPARAGRAPHS (D) AND (E) OF PARAGRAPH FOUR and
31 paragraphs seventeen and eighteen of subsection (b) of this section
32 shall not be subject to the deductible or coinsurance. The benefits
33 described in paragraph nine of subsection (b) of this section shall not
34 be subject to the deductible. The out-of-plan out-of-pocket maximum
35 deductible and coinsurance shall be established at three thousand
36 dollars per calendar year for an individual and five thousand dollars
37 per calendar year for a family. The out-of-plan lifetime benefit maximum
38 shall be established at five hundred thousand dollars.
39 S 9. Section 4406-c of the public health law is amended by adding a
40 new subdivision 8 to read as follows:
41 8. NO HEALTH MAINTENANCE ORGANIZATION WHICH PROVIDES COVERAGE FOR
42 SCREENING FOR COLON CANCER SHALL IMPOSE ANY COST-SHARING, DEDUCTIBLES OR
43 CO-INSURANCE OBLIGATIONS.
44 S 10. Subdivision 21 of section 296 of the executive law, as renum-
45 bered by chapter 536 of the laws of 2010, is renumbered subdivision 22
46 and a new subdivision 21 is added to read as follows:
47 21. IT SHALL BE AN UNLAWFUL DISCRIMINATORY PRACTICE FOR ANY EMPLOYER,
48 LABOR ORGANIZATION, INSURER, HEALTH MAINTENANCE ORGANIZATION OR OTHER
49 ENTITY TO IMPOSE ANY COST-SHARING, DEDUCTIBLES OR CO-INSURANCE OBLI-
50 GATIONS WHERE COVERAGE IS PROVIDED FOR SCREENING FOR COLON CANCER.
51 S 11. This act shall take effect immediately and the provisions of
52 this act shall apply to policies and contracts issued, renewed, modi-
53 fied, altered or amended on or after such effective date.