Requires providers of health care policies to provide coverage for colorectal cancer early detection for persons fifty years of age or older; requires the superintendent of insurance to provide notification to enrollees of such coverage via mail.

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S543-2013 Actions

• Jan 9, 2013: REFERRED TO INSURANCE

S543-2013 Memo

BILL NUMBER:S543

TITLE OF BILL:
An act
to amend the insurance law, in relation to providing insurance
coverage for colorectal
cancer early detection

PURPOSE:
This bill will require health insurance providers to cover
the costs of colon screening by colonoscopy in men and women age 50
and older.

SUMMARY OF PROVISIONS:
This bill amends paragraph 27 of subsection (i)
of section 3216 of the insurance law, as added by chapter 457 of the
laws of 2010, renumbered paragraph 30 and will add a new paragraph 32
to read as follows: (32) Every policy issued or delivered in this
state shall provide coverage for colon cancer screening for persons
fifty years of age or older. Such coverage shall include, but not be
limited to, the costs of a colonoscopy or coloscopy.

JUSTIFICATION:
Colon cancer is the second leading cancer killer in
America and is the primary cancer killer among nonsmokers. Without
preventative action, one in every 17 Americans will be diagnosed with
colon cancer. However, with colonoscopy screening, that risk is
reduced to as low as one in 100 people, Studies have found that a
colonoscopy can detect cancer in patients without symptoms that would
be missed by other screening methods. With such a preventative
screening technique, cancer is detected earlier and treatment is more
likely to be effective.

LEGISLATIVE HISTORY:
2012:  S.6941 Referred to Insurance

FISCAL IMPLICATIONS:
Any cost of enacting this legislation is far
overshadowed by potential lives and dollars saved by early detection
and treatment of colon cancer.

EFFECTIVE DATE:
This act shall take effect immediately and shall apply
to any policy issued, delivered, renewed, and/or modified on or after
the effective date of this act.

S543-2013 Text

                      S T A T E   O F   N E W   Y O R K
  ________________________________________________________________________

                                     543

                         2013-2014 Regular Sessions

                              I N  SENATE

                                 (PREFILED)

                               January 9, 2013
                                 ___________

  Introduced  by  Sen. KENNEDY -- 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:


    Section 1. Paragraph 27 of subsection  (i)  of  section  3216  of  the
  insurance  law,  as  added by chapter 457 of the laws of 2010, is renum-
  bered paragraph 30, paragraph 28 of subsection (i) of  section  3216  of
  the  insurance  law,  as  amended  by chapter 11 of the laws of 2012, is
  renumbered paragraph 31 and a new paragraph  32  is  added  to  read  as
  follows:

    (32) (A) EVERY POLICY WHICH PROVIDES COVERAGE PURSUANT TO THIS SECTION
  SHALL  PROVIDE  COVERAGE TO ANY NAMED SUBSCRIBER OR OTHER PERSON COVERED
  THEREUNDER FOR EXPENSES INCURRED IN CONDUCTING COLORECTAL  CANCER  EXAM-
  INATIONS  AND  LABORATORY TESTS AT REGULAR INTERVALS, INCLUDING EXPENSES
  INCURRED IN CONDUCTING PHYSICIAN  CONSULTATIONS  FOR  COLORECTAL  CANCER
  PRIOR  TO SUCH EXAMINATIONS AND TESTS, FOR PERSONS FIFTY YEARS OF AGE OR
  OLDER AND FOR PERSONS OF ANY AGE WHO ARE CONSIDERED TO BE AT  HIGH  RISK
  FOR COLORECTAL CANCER. THE METHODS OF SCREENING FOR WHICH BENEFITS SHALL
  BE PROVIDED SHALL INCLUDE BUT NOT BE LIMITED TO:

    (I) A SCREENING FECAL OCCULT BLOOD TEST;
    (II) FLEXIBLE SIGMOIDOSCOPY;
    (III) COLONOSCOPY;
    (IV) BARIUM ENEMA; OR
    (V)  THE MOST RELIABLE, MEDICALLY RECOGNIZED SCREENING TEST AVAILABLE;
  AND
    (VI) ANY COMBINATION THEREOF.
    THE METHOD AND FREQUENCY OF SCREENING  TO  BE  UTILIZED  SHALL  BE  IN
  ACCORD  WITH  THE  MOST  RECENTLY  PUBLISHED  GUIDELINES OF THE AMERICAN

   EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                        [ ] is old law to be omitted.
                                                             LBD02479-02-3

 S. 543                              2

  COLLEGE OF GASTROENTEROLOGY OR THE AMERICAN GASTROENTEROLOGICAL  ASSOCI-
  ATION IN CONSULTATION WITH THE AMERICAN CANCER SOCIETY.
    (B) AS USED IN THIS PARAGRAPH, "HIGH RISK FOR COLORECTAL CANCER" SHALL
  MEAN A PERSON HAS,
    (I)  A  FAMILY  HISTORY  OF FAMILIAL ADENOMATOUS POLYPOSIS; HEREDITARY
  NON-POLYPOSIS COLON CANCER; OR BREAST,  OVARIAN,  ENDOMETRIAL  OR  COLON
  CANCER OR POLYPS;
    (II) CHRONIC INFLAMMATORY BOWEL DISEASE; OR
    (III) A BACKGROUND, ETHNICITY OR LIFESTYLE THAT THE PHYSICIAN BELIEVES
  PUTS THE PERSON AT ELEVATED RISK FOR COLORECTAL CANCER.
    S 2. Subsection (k) of section 3221 of the insurance law is amended by
  adding a new paragraph 19 to read as follows:

    (19) (A) EVERY POLICY WHICH PROVIDES COVERAGE PURSUANT TO THIS SECTION
  SHALL  PROVIDE  COVERAGE TO ANY NAMED SUBSCRIBER OR OTHER PERSON COVERED
  THEREUNDER FOR EXPENSES INCURRED IN CONDUCTING COLORECTAL  CANCER  EXAM-
  INATIONS  AND  LABORATORY TESTS AT REGULAR INTERVALS, INCLUDING EXPENSES
  INCURRED IN CONDUCTING PHYSICIAN  CONSULTATIONS  FOR  COLORECTAL  CANCER
  PRIOR  TO SUCH EXAMINATIONS AND TESTS, FOR PERSONS FIFTY YEARS OF AGE OR
  OLDER AND FOR PERSONS OF ANY AGE WHO ARE CONSIDERED TO BE AT  HIGH  RISK
  FOR COLORECTAL CANCER. THE METHODS OF SCREENING FOR WHICH BENEFITS SHALL
  BE PROVIDED SHALL INCLUDE BUT NOT BE LIMITED TO:

    (I) A SCREENING FECAL OCCULT BLOOD TEST;
    (II) FLEXIBLE SIGMOIDOSCOPY;
    (III) COLONOSCOPY;
    (IV) BARIUM ENEMA; OR
    (V)  THE MOST RELIABLE, MEDICALLY RECOGNIZED SCREENING TEST AVAILABLE;
  AND
    (VI) ANY COMBINATION THEREOF.
    THE METHOD AND FREQUENCY OF SCREENING  TO  BE  UTILIZED  SHALL  BE  IN
  ACCORD  WITH  THE  MOST  RECENTLY  PUBLISHED  GUIDELINES OF THE AMERICAN
  COLLEGE OF GASTROENTEROLOGY OR THE AMERICAN GASTROENTEROLOGICAL  ASSOCI-
  ATION IN CONSULTATION WITH THE AMERICAN CANCER SOCIETY.
    (B) AS USED IN THIS PARAGRAPH, "HIGH RISK FOR COLORECTAL CANCER" SHALL
  MEAN A PERSON HAS,
    (I)  A  FAMILY  HISTORY  OF FAMILIAL ADENOMATOUS POLYPOSIS; HEREDITARY
  NON-POLYPOSIS COLON CANCER; OR BREAST,  OVARIAN,  ENDOMETRIAL  OR  COLON
  CANCER OR POLYPS;
    (II) CHRONIC INFLAMMATORY BOWEL DISEASE; OR
    (III) A BACKGROUND, ETHNICITY OR LIFESTYLE THAT THE PHYSICIAN BELIEVES
  PUTS THE PERSON AT ELEVATED RISK FOR COLORECTAL CANCER.
    S 3. Subsection (a) of section 4303 of the insurance law is amended by
  adding a new paragraph 4 to read as follows:

    (4) TO PERSONS FIFTY YEARS OF AGE OR OLDER FOR SERVICES RELATED TO THE
  CONDUCTING  OF  COLORECTAL  CANCER  EXAMINATIONS AND LABORATORY TESTS AT
  REGULAR INTERVALS, INCLUDING EXPENSES INCURRED IN  CONDUCTING  PHYSICIAN
  CONSULTATIONS  FOR  COLORECTAL  CANCER  PRIOR  TO  SUCH EXAMINATIONS AND
  TESTS, INCLUDING BUT NOT LIMITED TO, COLONOSCOPIES, COLOSCOPIES, SCREEN-
  ING FECAL OCCULT BLOOD TESTS, FLEXIBLE SIGMOIDOSCOPIES OR BARIUM ENEMAS.
    S 4. The superintendent of financial services shall require an  insur-
  er,  health  carrier or health benefit plan to notify enrollees annually
  of colorectal cancer screenings covered by such enrollees' health  bene-
  fit  plan  and  the  most  recently published guidelines of the American
  College of Gastroenterology or the American Gastroenterological  Associ-
  ation  in  consultation  with the American Cancer Society for colorectal
  cancer screenings or notify enrollees at intervals consistent  with  the
  most  recently published guidelines of the American College of Gastroen-

 S. 543                              3

  terology or the American Gastroenterological Association in consultation
  with the American Cancer Society of colorectal cancer  screenings  which
  are  covered  by such enrollees' health benefit plans.  The notice shall
  be  delivered by mail unless the enrollee and health carrier have agreed
  on another method  of  notification.  The  superintendent  of  financial
  services is authorized to promulgate necessary rules and regulations for
  the purposes of providing such notification.
    S  5.  This  act  shall take effect immediately and shall apply to any
  policy issued, delivered, renewed,  and/or  modified  on  or  after  the
  effective date of this act.