S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3268
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                             January 28, 2021
                                ___________
 
 Introduced  by  Sen.  PARKER -- 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  coverage  for  the
   detection of breast cancer
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (A) of  paragraph  11  of  subsection  (i)  of
 section 3216 of the insurance law, as amended by chapter 414 of the laws
 of  2017,  is  amended  and  a  new subparagraph (G) is added to read as
 follows:
   (A) Every policy that provides  coverage  for  hospital,  surgical  or
 medical  care  shall  provide  the  following  coverage  for mammography
 screening for occult breast cancer:
   (i) upon the recommendation of a physician, a mammogram, which may  be
 provided  by breast tomosynthesis, at any age for covered persons having
 a prior history of breast cancer or who have  a  first  degree  relative
 with a prior history of breast cancer;
   (ii)  a  single  baseline  mammogram,  which may be provided by breast
 tomosynthesis,  for  covered  persons  aged  [thirty-five]   TWENTY-FIVE
 through [thirty-nine] TWENTY-NINE, inclusive; and
   (iii) an annual mammogram, which may be provided by breast tomosynthe-
 sis, for covered persons aged [forty] THIRTY and older.
   (G)  COVERAGE  SHALL  ALSO  BE  PROVIDED, UPON THE RECOMMENDATION OF A
 PHYSICIAN, FOR FOLLOW-UP DIAGNOSTIC TESTING FOR THE DETECTION OF  BREAST
 CANCER,  INCLUDING BREAST BIOPSIES, IN THE EVENT THAT A PHYSICIAN DETER-
 MINES THAT A COVERED PERSON HAS HAD AN ABNORMAL MAMMOGRAM. SUCH  FOLLOW-
 UP  DIAGNOSTIC  TESTING  SHALL  NOT  BE SUBJECT TO ANNUAL DEDUCTIBLES OR
 COINSURANCE.
   § 2. Subparagraph (A) of paragraph 11 of  subsection  (l)  of  section
 3221  of  the  insurance  law,  as amended by chapter 143 of the laws of
 2019, is amended and a new subparagraph (G) is added to read as follows:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD07272-01-1

 S. 3268                             2
 
   (A) Every insurer delivering a group or blanket policy  or  issuing  a
 group  or blanket policy for delivery in this state that provides cover-
 age for hospital, surgical or medical care shall provide  the  following
 coverage for mammography screening for occult breast cancer:
   (i)  upon the recommendation of a physician, a mammogram, which may be
 provided by breast tomosynthesis, at any age for covered persons  having
 a  prior  history  of  breast cancer or who have a first degree relative
 with a prior history of breast cancer;
   (ii) a single baseline mammogram, which  may  be  provided  by  breast
 tomosynthesis,   for  covered  persons  aged  [thirty-five]  TWENTY-FIVE
 through [thirty-nine] TWENTY-NINE, inclusive;
   (iii) an annual mammogram, which may be provided by breast tomosynthe-
 sis, for covered persons aged [forty] THIRTY and older; and
   (iv) for large group policies  that  provide  coverage  for  hospital,
 surgical  or  medical care, an annual mammogram for covered persons aged
 [thirty-five] TWENTY-FIVE through [thirty-nine] TWENTY-NINE,  inclusive,
 upon  the recommendation of a physician, subject to the insurer's deter-
 mination that the mammogram is medically necessary.
   (G) COVERAGE SHALL ALSO BE PROVIDED,  UPON  THE  RECOMMENDATION  OF  A
 PHYSICIAN,  FOR FOLLOW-UP DIAGNOSTIC TESTING FOR THE DETECTION OF BREAST
 CANCER, INCLUDING BREAST BIOPSIES, IN THE EVENT THAT A PHYSICIAN  DETER-
 MINES  THAT A COVERED PERSON HAS HAD AN ABNORMAL MAMMOGRAM. SUCH FOLLOW-
 UP DIAGNOSTIC TESTING SHALL NOT BE  SUBJECT  TO  ANNUAL  DEDUCTIBLES  OR
 COINSURANCE.
   §  3.  Subparagraphs (B), (C) and (D) of paragraph 1 of subsection (p)
 of section 4303 of the insurance law, as amended by chapter 143  of  the
 laws  of  2019,  are  amended  and a new paragraph 6 is added to read as
 follows:
   (B) a single baseline mammogram, which may be provided by breast tomo-
 synthesis, for covered persons aged  [thirty-five]  TWENTY-FIVE  through
 [thirty-nine] TWENTY-NINE, inclusive;
   (C) an annual mammogram, which may be provided by breast tomosythesis,
 for covered persons aged [forty] THIRTY and older;
   (D)  for  large group contracts offered by a medical expense indemnity
 corporation, a hospital service corporation or a health  service  corpo-
 ration  that provide coverage for hospital, surgical or medical care, an
 annual mammogram for  covered  persons  aged  [thirty-five]  TWENTY-FIVE
 through [thirty-nine] TWENTY-NINE, inclusive, upon the recommendation of
 a  physician, subject to the corporation's determination that the mammo-
 gram is medically necessary; and
   (6) COVERAGE SHALL ALSO BE PROVIDED,  UPON  THE  RECOMMENDATION  OF  A
 PHYSICIAN,  FOR FOLLOW-UP DIAGNOSTIC TESTING FOR THE DETECTION OF BREAST
 CANCER, INCLUDING BREAST BIOPSIES, IN THE EVENT THAT A PHYSICIAN  DETER-
 MINES  THAT A COVERED PERSON HAS HAD AN ABNORMAL MAMMOGRAM. SUCH FOLLOW-
 UP DIAGNOSTIC TESTING SHALL NOT BE  SUBJECT  TO  ANNUAL  DEDUCTIBLES  OR
 COINSURANCE.
   §  4.  This  act shall take effect on the ninetieth day after it shall
 have become a law and shall apply to all policies and contracts  issued,
 renewed, modified, altered or amended on or after such date.