S T A T E O F N E W Y O R K
________________________________________________________________________
7881
I N S E N A T E
January 18, 2022
___________
Introduced by Sen. STAVISKY -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law and the public health law, in relation
to providing coverage and information on chest wall reconstruction
surgery after a mastectomy or partial mastectomy
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subparagraph (A) of paragraph 20 of subsection (i) of
section 3216 of the insurance law, as added by chapter 21 of the laws of
1997, the opening paragraph and clause (i) as amended by chapter 302 of
the laws of 2012, is amended to read as follows:
(A) Every policy which provides medical, major medical, or similar
comprehensive-type coverage shall provide the following coverage for
breast OR CHEST WALL reconstruction surgery after a mastectomy or
partial mastectomy:
(i) all stages of reconstruction of the breast OR CHEST WALL on which
the mastectomy or partial mastectomy has been performed; and
(ii) surgery and reconstruction of the other breast OR CHEST WALL to
produce a symmetrical appearance;
in the manner determined by the attending physician and the patient to
be appropriate. CHEST WALL RECONSTRUCTION SURGERY SHALL INCLUDE AESTHET-
IC FLAT CLOSURE AS SUCH TERM IS DEFINED BY THE NATIONAL CANCER INSTI-
TUTE. Such coverage may be subject to annual deductibles and coinsurance
provisions as may be deemed appropriate by the superintendent and as are
consistent with those established for other benefits within a given
policy. Written notice of the availability of such coverage shall be
delivered to the policyholder prior to inception of such policy and
annually thereafter.
§ 2. Subparagraph (A) of paragraph 10 of subsection (k) of section
3221 of the insurance law, as added by chapter 21 of the laws of 1997,
the opening paragraph and clause (i) as amended by chapter 302 of the
laws of 2012, is amended to read as follows:
(A) Every group or blanket policy delivered or issued for delivery in
this state which provides medical, major medical, or similar comprehen-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD13570-01-1
S. 7881 2
sive-type coverage shall provide the following coverage for breast OR
CHEST WALL reconstruction surgery after a mastectomy or partial mastec-
tomy:
(i) all stages of reconstruction of the breast OR CHEST WALL on which
the mastectomy or partial mastectomy has been performed; and
(ii) surgery and reconstruction of the other breast OR CHEST WALL to
produce a symmetrical appearance;
in the manner determined by the attending physician and the patient to
be appropriate. CHEST WALL RECONSTRUCTION SURGERY SHALL INCLUDE AESTHET-
IC FLAT CLOSURE AS SUCH TERM IS DEFINED BY THE NATIONAL CANCER INSTI-
TUTE. Such coverage may be subject to annual deductibles and coinsurance
provisions as may be deemed appropriate by the superintendent and as are
consistent with those established for other benefits within a given
policy. Written notice of the availability of such coverage shall be
delivered to the policyholder prior to inception of such policy and
annually thereafter.
§ 3. Paragraph 1 of subsection (x) of section 4303 of the insurance
law, as added by chapter 21 of the laws of 1997, the opening paragraph
and subparagraph (A) as amended by chapter 302 of the laws of 2012, is
amended to read as follows:
(1) Every contract issued by a medical expense indemnity corporation,
hospital service corporation or health service corporation which
provides coverage for surgical or medical care shall provide the follow-
ing coverage for breast OR CHEST WALL reconstruction surgery after a
mastectomy or partial mastectomy:
(A) all stages of reconstruction of the breast OR CHEST WALL on which
the mastectomy or partial mastectomy has been performed; and
(B) surgery and reconstruction of the other breast OR CHEST WALL to
produce a symmetrical appearance;
in the manner determined by the attending physician and the patient to
be appropriate. CHEST WALL RECONSTRUCTION SURGERY SHALL INCLUDE AESTHET-
IC FLAT CLOSURE AS SUCH TERM IS DEFINED BY THE NATIONAL CANCER INSTI-
TUTE. Such coverage may be subject to annual deductibles or coinsurance
provisions as may be deemed appropriate by the superintendent and as are
consistent with those established for other benefits within a given
policy. Written notice of the availability of such coverage shall be
delivered to the group remitting agent or group contract holder prior to
the inception of such contract and annually thereafter.
§ 4. Subdivisions 1 and 1-a of section 2404 of the public health law,
subdivision 1 as amended by chapter 179 of the laws of 1991 and subdivi-
sion 1-a as added by chapter 20 of the laws of 1997, are amended to read
as follows:
1. The commissioner shall develop a standardized written summary, in
plain non-technical language, which shall explain the alternative
medically viable methods of treating breast cancer, including but not
limited to hormonal, radiological, chemotherapeutic or surgical treat-
ments, or combinations thereof. The summary shall contain information on
breast OR CHEST WALL reconstructive surgery, including but not limited
to, the use of breast implants, their side effects, risks and other
pertinent information to aid a person in deciding on a course of treat-
ment. CHEST WALL RECONSTRUCTIVE INFORMATION SHALL INCLUDE INFORMATION
ON AESTHETIC FLAT CLOSURE AS SUCH TERM IS DEFINED BY THE NATIONAL CANCER
INSTITUTE.
1-a. The informational summary shall also include an explanation of
the special provisions relating to mastectomy, lymph node dissection, or
lumpectomy, and breast OR CHEST WALL reconstructive surgery coverage,
S. 7881 3
and second opinion coverage (including out-of-network options) under the
insurance law and section twenty-eight hundred three-o of this chapter,
and suggest that patients undergoing such procedures check their health
plans and/or insurance policies for the details of their coverage.
§ 5. Subdivision 2 of section 2803-o of the public health law, as
added by chapter 354 of the laws of 2010, is amended to read as follows:
2. Every general hospital that provides mastectomy surgery, lymph node
dissection or a lumpectomy shall provide information to the patient
concerning the option of reconstructive surgery following such proce-
dures, including BOTH BREAST AND CHEST WALL RECONSTRUCTIVE SURGERY AND
the availability of coverage for reconstructive surgery, in accordance
with the provisions of sections three thousand two hundred sixteen,
three thousand two hundred twenty-one and four thousand three hundred
three of the insurance law and applicable provisions of federal law. The
information shall be provided to the patient in writing and in advance
of obtaining consent to the surgical procedure. The information provided
shall include at least the following:
(a) a description of the various reconstructive options and the advan-
tages and disadvantages of each. SUCH DESCRIPTION SHALL INCLUDE AESTHET-
IC FLAT CLOSURE AS SUCH TERM IS DEFINED BY THE NATIONAL CANCER
INSTITUTE;
(b) a description of the provisions assuring coverage by public and
private insurance plans of the costs related to reconstructive surgery
under federal and state law;
(c) a description of how a patient may access reconstructive care,
including the potential of transferring care to a facility that provides
reconstructive care or choosing to pursue reconstruction after
completion of breast cancer surgery and chemo/radiotherapy, if
warranted;
(d) such other information as may be required by the commissioner.
§6. 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.
