Actions

Text

STATE OF NEW YORK
________________________________________________________________________

4378--A

2011-2012 Regular Sessions

IN ASSEMBLY

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:

  Section 1. Subparagraph (B) of paragraph 11 and  subparagraph  (C)  of
paragraph  15  of  subsection  (i) of section 3216 of the insurance law,
subparagraph (B) of paragraph 11 as added by chapter 417 of the laws  of
1989  and  subparagraph  (C) of paragraph 15 as amended by chapter 43 of
the laws of 1993, are amended to read as follows:
  (B) Such coverage [may] SHALL NOT be subject to annual deductibles and
coinsurance [as may be deemed appropriate by the superintendent  and  as
are  consistent with those established for other benefits within a given
policy].
  (C) Such coverage [may] SHALL NOT be subject to annual deductibles and
coinsurance [as may be deemed appropriate by the superintendent  and  as
are  consistent with those established for other benefits within a given
policy].
  S 2. Subsection (i) of section 3216 of the insurance law is amended by
adding a new paragraph 28 to read as follows:
  (28) NO POLICY DELIVERED OR ISSUED FOR DELIVERY IN  THIS  STATE  WHICH
PROVIDES  COVERAGE FOR SCREENING FOR COLON CANCER SHALL IMPOSE ANY COST-
SHARING, DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS.
  S 3.  Subparagraph (B) of paragraph 11 and subparagraph (C)  of  para-
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

amended by chapter 554 of the laws of  2002,  are  amended  to  read  as
follows:
  (B) Such coverage [may] SHALL NOT be subject to annual deductibles and
coinsurance  [as  may be deemed appropriate by the superintendent and as
are consistent with those established for other benefits within a  given
policy].
  (C) Such coverage [may] SHALL NOT be subject to annual deductibles and
coinsurance  [as  may be deemed appropriate by the superintendent and as
are consistent with those established for other benefits within a  given
policy].
  S 4. Subsection (a) of section 3221 of the insurance law is amended by
adding a new paragraph 17 to read as follows:
  (17)  NO  POLICY  DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE WHICH
PROVIDES COVERAGE FOR SCREENING FOR COLON CANCER SHALL IMPOSE ANY  COST-
SHARING, DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS.
  S  5. The closing paragraph of paragraph 1 of subsection (p) and para-
graph 1 of subsection (t) of section  4303  of  the  insurance  law,  as
amended  by  chapter  554  of  the  laws of 2002, are amended to read as
follows:
  The coverage required in this paragraph [may] SHALL NOT  be subject to
annual deductibles and coinsurance [as may be deemed appropriate by  the
superintendent  and  as  are consistent with those established for other
benefits within a given policy].
  (1) A medical expense indemnity corporation, a hospital service corpo-
ration or a health  service  corporation  which  provides  coverage  for
hospital, surgical, or medical care shall provide coverage for an annual
cervical cytology screening for cervical cancer and its precursor states
for  women  aged  eighteen and older.   Such coverage [may] SHALL NOT be
subject to annual deductibles and coinsurance [as may be  deemed  appro-
priate  by  the  superintendent  and as are consistent with those estab-
lished for other benefits within a given contract].
  S 6. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (hh) to read as follows:
  (HH)  NO  MEDICAL  EXPENSE  INDEMNITY  CORPORATION, A HOSPITAL SERVICE
CORPORATION OR A HEALTH SERVICE CORPORATION WHICH PROVIDES COVERAGE  FOR
SCREENING FOR COLON CANCER SHALL IMPOSE ANY COST-SHARING, DEDUCTIBLES OR
CO-INSURANCE OBLIGATIONS.
  S  7. Subsection (c) of section 4321 of the insurance law, as added by
chapter 504 of the laws of 1995, is amended to read as follows:
  (c) The health maintenance organization shall impose a fifteen  dollar
copayment on all visits to a physician or other provider with the excep-
tion  of  visits  for pre-natal and post-natal care or well child visits
provided pursuant  to  paragraph  two  of  subsection  (j),  MAMMOGRAPHY
SCREENING  PROVIDED  PURSUANT  TO  SUBSECTION (P), AND CERVICAL CYTOLOGY
SCREENING PROVIDED PURSUANT TO SUBSECTION (T) of section  four  thousand
three  hundred three of this article for which no copayment shall apply.
A copayment of fifteen dollars shall be imposed on  equipment,  supplies
and  self-management  education  for  the treatment of diabetes. A fifty
dollar copayment shall be imposed on emergency services rendered in  the
emergency  room of a hospital; however, this copayment must be waived if
hospital admission results. Surgical services  shall  be  subject  to  a
copayment  of  the lesser of twenty percent of the cost of such services
or two hundred dollars per occurrence. A five hundred  dollar  copayment
shall  be imposed on inpatient hospital services per continuous hospital
confinement. Ambulatory surgical services shall be subject to a facility
copayment charge of seventy-five dollars.  Coinsurance  of  ten  percent
A. 4378--A                          3

shall apply to visits for the diagnosis and treatment of mental, nervous
or emotional disorders or ailments.
  S  8. Subsections (c) and (d) of section 4322 of the insurance law, as
added by chapter 504 of the  laws  of  1995,  are  amended  to  read  as
follows:
  (c)  The in-plan benefit system shall impose a ten dollar copayment on
all visits to a physician or other provider with the exception of visits
for pre-natal and post-natal care or well child visits provided pursuant
to paragraph two  of  subsection  (j),  MAMMOGRAPHY  SCREENING  PROVIDED
PURSUANT  TO  SUBSECTION  (P),  AND CERVICAL CYTOLOGY SCREENING PROVIDED
PURSUANT TO SUBSECTION (T) of section four thousand three hundred  three
of  this  article for which no copayment shall apply. A copayment of ten
dollars shall be imposed  on  equipment,  supplies  and  self-management
education  for  the  treatment  of  diabetes. Coinsurance of ten percent
shall apply to visits for the diagnosis and treatment of mental, nervous
or emotional disorders or ailments. A thirty-five dollar copayment shall
be imposed on emergency services rendered in the  emergency  room  of  a
hospital;  however,  this copayment must be waived if hospital admission
results.
  (d) The out-of-plan benefit system shall  have  an  annual  deductible
established  at one thousand dollars per calendar year for an individual
and two thousand dollars per year for a  family.  Coinsurance  shall  be
established  at  twenty percent with the health maintenance organization
or insurer paying eighty percent of the usual, customary and  reasonable
charges, or eighty percent of the amounts listed on a fee schedule filed
with  and  approved  by  the  superintendent which provides a comparable
level of reimbursement. Coinsurance of ten percent shall apply to outpa-
tient visits for the diagnosis  and  treatment  of  mental,  nervous  or
emotional  disorders or ailments. The benefits described in subparagraph
(F) of paragraph three, SUBPARAGRAPHS (D) AND (E) OF PARAGRAPH FOUR  and
paragraphs  seventeen  and  eighteen  of  subsection (b) of this section
shall not be subject to the  deductible  or  coinsurance.  The  benefits
described  in paragraph nine of subsection (b) of this section shall not
be subject to the  deductible.  The  out-of-plan  out-of-pocket  maximum
deductible  and  coinsurance  shall  be  established  at  three thousand
dollars per calendar year for an individual and  five  thousand  dollars
per calendar year for a family. The out-of-plan lifetime benefit maximum
shall be established at five hundred thousand dollars.
  S  9.  Section  4406-c of the public health law is amended by adding a
new subdivision 8 to read as follows:
  8. NO HEALTH MAINTENANCE  ORGANIZATION  WHICH  PROVIDES  COVERAGE  FOR
SCREENING FOR COLON CANCER SHALL IMPOSE ANY COST-SHARING, DEDUCTIBLES OR
CO-INSURANCE OBLIGATIONS.
  S  10.  Subdivision  21 of section 296 of the executive law, as renum-
bered by chapter 536 of the laws of 2010, is renumbered  subdivision  22
and a new subdivision 21 is added to read as follows:
  21.  IT SHALL BE AN UNLAWFUL DISCRIMINATORY PRACTICE FOR ANY EMPLOYER,
LABOR ORGANIZATION, INSURER, HEALTH MAINTENANCE  ORGANIZATION  OR  OTHER
ENTITY  TO  IMPOSE  ANY  COST-SHARING, DEDUCTIBLES OR CO-INSURANCE OBLI-
GATIONS WHERE COVERAGE IS PROVIDED FOR SCREENING FOR COLON CANCER.
  S 11. This act shall take effect immediately  and  the  provisions  of
this  act  shall  apply to policies and contracts issued, renewed, modi-
fied, altered or amended on or after such effective date.