S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1876
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 23, 2023
                                ___________
 
 Introduced by M. of A. L. ROSENTHAL, LAVINE, THIELE, SANTABARBARA, STECK
   --  Multi-Sponsored  by  -- M. of A. COOK -- read once and referred to
   the Committee on Insurance
 
 AN ACT to amend the insurance law,  in  relation  to  requiring  certain
   health insurance coverage for lymphedema

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Clauses (i) and (ii) of subparagraph (A) of paragraph 20 of
 subsection (i) of section 3216 of the insurance law, as amended by chap-
 ter 571 of the laws of 2022, are amended and a new clause (iii) is added
 to read as follows:
   (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[.]; AND
   (III) PROSTHESES AND PHYSICAL COMPLICATIONS OF ALL STAGES OF MASTECTO-
 MY, INCLUDING LYMPHEDEMA;
   § 2. Subsection (i) of section 3216 of the insurance law is amended by
 adding two new paragraphs 39 and 40 to read as follows:
   (39)  EVERY POLICY WHICH PROVIDES HOSPITAL, SURGICAL, MEDICAL OR MAJOR
 MEDICAL COVERAGE SHALL PROVIDE COVERAGE FOR THE  DIFFERENTIAL  DIAGNOSIS
 AND  TREATMENT  OF  LYMPHEDEMA,  BOTH  PRIMARY AND SECONDARY LYMPHEDEMA.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD06690-01-3
              

 A. 1876                             2
 
 SUCH COVERAGE SHALL INCLUDE, IN ADDITION TO BENEFITS  FOR  A  COURSE  OF
 MANUAL  LYMPH DRAINAGE WHOSE FREQUENCY AND DURATION IS DETERMINED BY THE
 TREATING PHYSICIAN OR THERAPIST BASED ON MEDICAL NECESSITY AND NOT BASED
 ON  PHYSICAL  THERAPY  AND REHABILITATION STANDARDS, BENEFITS FOR EQUIP-
 MENT, SUPPLIES, DEVICES, COMPLEX DECONGESTIVE THERAPY,  AND  OUT-PATIENT
 SELF-MANAGEMENT  TRAINING AND EDUCATION FOR THE TREATMENT OF LYMPHEDEMA,
 IF PRESCRIBED BY  A  HEALTH  CARE  PROFESSIONAL  LEGALLY  AUTHORIZED  TO
 PRESCRIBE  OR PROVIDE SUCH ITEMS UNDER TITLE EIGHT OF THE EDUCATION LAW.
 LYMPHEDEMA THERAPY ADMINISTERED UNDER THIS SECTION SHALL BE ADMINISTERED
 ONLY BY A THERAPIST CERTIFIED TO PERFORM  LYMPHEDEMA  TREATMENT  BY  THE
 LYMPHOLOGY  ASSOCIATION  OF NORTH AMERICA (LANA) OR CERTIFIED IN ACCORD-
 ANCE WITH STANDARDS EQUIVALENT TO THE CERTIFICATION STANDARDS  OF  LANA.
 SUCH  EQUIPMENT,  SUPPLIES  OR DEVICES SHALL INCLUDE, BUT NOT BE LIMITED
 TO, BANDAGES, COMPRESSION GARMENTS, PADS, ORTHOTIC  SHOES  AND  DEVICES,
 WITH  REPLACEMENTS  WHEN REQUIRED TO MAINTAIN COMPRESSIVE FUNCTION OR TO
 ACCOMMODATE CHANGES IN  THE  PATIENT'S  DIMENSIONS.  COVERAGE  SHALL  BE
 PROVIDED  FOR FOLLOW-UP TREATMENTS WHEN MEDICALLY REQUIRED OR TO PERIOD-
 ICALLY VALIDATE HOME TECHNIQUES, TO MONITOR PROGRESS AGAINST THE WRITTEN
 TREATMENT PLAN AND TO MODIFY THE TREATMENT PLAN AS REQUIRED. NO INDIVID-
 UAL, OTHER THAN A LICENSED PHYSICIAN OR SURGEON  COMPETENT  TO  EVALUATE
 THE  SPECIFIC  CLINICAL  ISSUES INVOLVED IN THE CARE REQUESTED, MAY DENY
 REQUESTS FOR AUTHORIZATION OF HEALTH  CARE  SERVICES  PURSUANT  TO  THIS
 SECTION.
   (A)  A  POLICY WHICH IS A MANAGED HEALTH CARE PRODUCT MAY REQUIRE SUCH
 HEALTH CARE PROFESSIONAL BE A MEMBER OF SUCH MANAGED HEALTH CARE  PLAN'S
 PROVIDER  NETWORK, PROVIDED THAT SUCH NETWORK INCLUDES SUFFICIENT HEALTH
 CARE PROFESSIONALS WHO ARE QUALIFIED BY SPECIFIC  EDUCATION,  EXPERIENCE
 AND  CREDENTIALS TO PROVIDE THE COVERED BENEFITS DESCRIBED IN THIS PARA-
 GRAPH.
   (B) NO INSURER, CORPORATION, OR HEALTH MAINTENANCE ORGANIZATION  SHALL
 IMPOSE UPON ANY PERSON RECEIVING BENEFITS PURSUANT TO THIS PARAGRAPH ANY
 COPAYMENT,  FEE,  POLICY  YEAR  OR  CALENDAR YEAR, OR DURATIONAL BENEFIT
 LIMITATION OR MAXIMUM FOR BENEFITS  OR  SERVICES  THAT  IS  NOT  EQUALLY
 IMPOSED UPON ALL INDIVIDUALS IN THE SAME BENEFIT CATEGORY.
   (C)  THIS  PARAGRAPH  SHALL  NOT  APPLY TO SHORT-TERM TRAVEL, ACCIDENT
 ONLY, LIMITED OR SPECIFIED DISEASE, OR INDIVIDUAL CONVERSION POLICIES OR
 CONTRACTS, NOR TO POLICIES OR CONTRACTS DESIGNED FOR ISSUANCE TO PERSONS
 ELIGIBLE FOR COVERAGE UNDER TITLE XVIII  OF  THE  SOCIAL  SECURITY  ACT,
 KNOWN  AS MEDICARE, OR ANY OTHER SIMILAR COVERAGE UNDER STATE OR FEDERAL
 GOVERNMENTAL PLANS.
   (D) FOR PURPOSES OF THIS PARAGRAPH, A  "MANAGED  CARE  PRODUCT"  SHALL
 MEAN  A POLICY WHICH REQUIRES THAT MEDICAL OR OTHER HEALTH CARE SERVICES
 COVERED UNDER  THE  POLICY,  OTHER  THAN  EMERGENCY  CARE  SERVICES,  BE
 PROVIDED BY, OR PURSUANT TO A REFERRAL FROM A PRIMARY CARE PROVIDER, AND
 THAT  SERVICES  PROVIDED  PURSUANT  TO  SUCH A REFERRAL BE RENDERED BY A
 HEALTH CARE PROVIDER PARTICIPATING IN THE INSURER'S MANAGED CARE PROVID-
 ER NETWORK. IN ADDITION, A MANAGED CARE  PRODUCT  SHALL  ALSO  MEAN  THE
 IN-NETWORK  PORTION  OF  A CONTRACT WHICH REQUIRES THAT MEDICAL OR OTHER
 HEALTH CARE SERVICES COVERED UNDER THE CONTRACT,  OTHER  THAN  EMERGENCY
 CARE  SERVICES, BE PROVIDED BY, OR PURSUANT TO A REFERRAL FROM A PRIMARY
 CARE PROVIDER, AND THAT SERVICES PROVIDED PURSUANT TO SUCH A REFERRAL BE
 RENDERED BY A  HEALTH  CARE  PROVIDER  PARTICIPATING  IN  THE  INSURER'S
 MANAGED  CARE  PROVIDER NETWORK, IN ORDER FOR THE INSURED TO BE ENTITLED
 TO THE MAXIMUM REIMBURSEMENT UNDER THE CONTRACT.
   (40) PATIENTS UNDERGOING ANY SURGERY OR RADIOTHERAPY  PROCEDURE  SHALL
 BE  PROVIDED  INFORMATION ON THE RISK OF LYMPHEDEMA ASSOCIATED WITH THAT
 A. 1876                             3
 
 PROCEDURE, AND THE  POTENTIAL  POST-PROCEDURE  SYMPTOMS  OF  LYMPHEDEMA.
 INFORMED  CONSENT  AGREEMENTS  FOR ALL SURGERIES AND RADIATION THERAPIES
 SHALL INCLUDE INFORMATION ON THE RISK OF LYMPHEDEMA ASSOCIATED WITH  THE
 ALTERNATIVE PROCEDURES.
   §  3.  Clauses  (i)  and  (ii)  of subparagraph (A) of paragraph 10 of
 subsection (k) of section 3221 of the insurance law, as amended by chap-
 ter 571 of the laws of 2022, are amended and a new clause (iii) is added
 to read as follows:
   (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[.]; AND
   (III) PROSTHESES AND PHYSICAL COMPLICATIONS OF ALL STAGES OF MASTECTO-
 MY, INCLUDING LYMPHEDEMA;
   § 4. Subsection (k) of section 3221 of the insurance law is amended by
 adding two new paragraphs 23 and 24 to read as follows:
   (23)  EVERY  GROUP  POLICY ISSUED OR ISSUED FOR DELIVERY IN THIS STATE
 WHICH PROVIDES HOSPITAL, SURGICAL, MEDICAL  OR  MAJOR  MEDICAL  COVERAGE
 SHALL  PROVIDE  COVERAGE FOR THE DIFFERENTIAL DIAGNOSIS AND TREATMENT OF
 LYMPHEDEMA, BOTH PRIMARY AND SECONDARY LYMPHEDEMA.  SUCH COVERAGE  SHALL
 INCLUDE,  IN  ADDITION TO BENEFITS FOR A COURSE OF MANUAL LYMPH DRAINAGE
 WHOSE FREQUENCY AND DURATION IS DETERMINED BY THE TREATING PHYSICIAN  OR
 THERAPIST  BASED  ON MEDICAL NECESSITY AND NOT BASED ON PHYSICAL THERAPY
 AND REHABILITATION STANDARDS, BENEFITS FOR EQUIPMENT, SUPPLIES, DEVICES,
 COMPLEX DECONGESTIVE THERAPY, AND OUT-PATIENT  SELF-MANAGEMENT  TRAINING
 AND EDUCATION FOR THE TREATMENT OF LYMPHEDEMA, IF PRESCRIBED BY A HEALTH
 CARE  PROFESSIONAL LEGALLY AUTHORIZED TO PRESCRIBE OR PROVIDE SUCH ITEMS
 UNDER TITLE EIGHT OF THE EDUCATION LAW.  LYMPHEDEMA THERAPY ADMINISTERED
 UNDER THIS SECTION SHALL BE ADMINISTERED ONLY BY A  THERAPIST  CERTIFIED
 TO  PERFORM  LYMPHEDEMA TREATMENT BY THE LYMPHOLOGY ASSOCIATION OF NORTH
 AMERICA (LANA) OR CERTIFIED IN ACCORDANCE WITH STANDARDS  EQUIVALENT  TO
 THE  CERTIFICATION  STANDARDS  OF  LANA.    SUCH  EQUIPMENT, SUPPLIES OR
 DEVICES SHALL INCLUDE, BUT NOT  BE  LIMITED  TO,  BANDAGES,  COMPRESSION
 GARMENTS,  PADS,  ORTHOTIC  SHOES  AND  DEVICES,  WITH REPLACEMENTS WHEN
 REQUIRED TO MAINTAIN COMPRESSIVE FUNCTION OR TO ACCOMMODATE  CHANGES  IN
 THE  PATIENT'S  DIMENSIONS.  COVERAGE  SHALL  BE  PROVIDED FOR FOLLOW-UP
 TREATMENTS WHEN MEDICALLY REQUIRED  OR  TO  PERIODICALLY  VALIDATE  HOME
 TECHNIQUES,  TO  MONITOR PROGRESS AGAINST THE WRITTEN TREATMENT PLAN AND
 TO MODIFY THE TREATMENT PLAN AS REQUIRED. NO INDIVIDUAL,  OTHER  THAN  A
 LICENSED  PHYSICIAN  OR SURGEON COMPETENT TO EVALUATE THE SPECIFIC CLIN-
 ICAL ISSUES INVOLVED IN  THE  CARE  REQUESTED,  MAY  DENY  REQUESTS  FOR
 AUTHORIZATION OF HEALTH CARE SERVICES PURSUANT TO THIS SECTION.
   (A)  A  POLICY WHICH IS A MANAGED HEALTH CARE PRODUCT MAY REQUIRE SUCH
 HEALTH CARE PROFESSIONAL BE A MEMBER OF SUCH MANAGED HEALTH CARE  PLAN'S
 PROVIDER  NETWORK, PROVIDED THAT SUCH NETWORK INCLUDES SUFFICIENT HEALTH
 CARE PROFESSIONALS WHO ARE QUALIFIED BY SPECIFIC  EDUCATION,  EXPERIENCE
 A. 1876                             4

 AND  CREDENTIALS TO PROVIDE THE COVERED BENEFITS DESCRIBED IN THIS PARA-
 GRAPH.
   (B)  NO INSURER, CORPORATION, OR HEALTH MAINTENANCE ORGANIZATION SHALL
 IMPOSE UPON ANY PERSON RECEIVING BENEFITS PURSUANT TO THIS PARAGRAPH ANY
 COPAYMENT, FEE, POLICY YEAR OR  CALENDAR  YEAR,  OR  DURATIONAL  BENEFIT
 LIMITATION  OR  MAXIMUM  FOR  BENEFITS  OR  SERVICES THAT IS NOT EQUALLY
 IMPOSED UPON ALL INDIVIDUALS IN THE SAME BENEFIT CATEGORY.
   (C) THIS PARAGRAPH SHALL NOT  APPLY  TO  SHORT-TERM  TRAVEL,  ACCIDENT
 ONLY, LIMITED OR SPECIFIED DISEASE, OR INDIVIDUAL CONVERSION POLICIES OR
 CONTRACTS, NOR TO POLICIES OR CONTRACTS DESIGNED FOR ISSUANCE TO PERSONS
 ELIGIBLE  FOR  COVERAGE  UNDER  TITLE  XVIII OF THE SOCIAL SECURITY ACT,
 KNOWN AS MEDICARE, OR ANY OTHER SIMILAR COVERAGE UNDER STATE OR  FEDERAL
 GOVERNMENTAL PLANS.
   (D)  FOR  PURPOSES  OF  THIS PARAGRAPH, A "MANAGED CARE PRODUCT" SHALL
 MEAN A POLICY WHICH REQUIRES THAT MEDICAL OR OTHER HEALTH CARE  SERVICES
 COVERED  UNDER  THE  POLICY,  OTHER  THAN  EMERGENCY  CARE  SERVICES, BE
 PROVIDED BY, OR PURSUANT TO A REFERRAL FROM A PRIMARY CARE PROVIDER, AND
 THAT SERVICES PROVIDED PURSUANT TO SUCH A  REFERRAL  BE  RENDERED  BY  A
 HEALTH CARE PROVIDER PARTICIPATING IN THE INSURER'S MANAGED CARE PROVID-
 ER  NETWORK.  IN  ADDITION,  A  MANAGED CARE PRODUCT SHALL ALSO MEAN THE
 IN-NETWORK PORTION OF A CONTRACT WHICH REQUIRES THAT  MEDICAL  OR  OTHER
 HEALTH  CARE  SERVICES  COVERED UNDER THE CONTRACT, OTHER THAN EMERGENCY
 CARE SERVICES, BE PROVIDED BY, OR PURSUANT TO A REFERRAL FROM A  PRIMARY
 CARE PROVIDER, AND THAT SERVICES PROVIDED PURSUANT TO SUCH A REFERRAL BE
 RENDERED  BY  A  HEALTH  CARE  PROVIDER  PARTICIPATING  IN THE INSURER'S
 MANAGED CARE PROVIDER NETWORK, IN ORDER FOR THE INSURED TO  BE  ENTITLED
 TO THE MAXIMUM REIMBURSEMENT UNDER THE CONTRACT.
   (24)  PATIENTS  UNDERGOING ANY SURGERY OR RADIOTHERAPY PROCEDURE SHALL
 BE PROVIDED INFORMATION ON THE RISK OF LYMPHEDEMA ASSOCIATED  WITH  THAT
 PROCEDURE,  AND  THE  POTENTIAL  POST-PROCEDURE  SYMPTOMS OF LYMPHEDEMA.
 INFORMED CONSENT AGREEMENTS FOR ALL SURGERIES  AND  RADIATION  THERAPIES
 SHALL  INCLUDE INFORMATION ON THE RISK OF LYMPHEDEMA ASSOCIATED WITH THE
 ALTERNATIVE PROCEDURES.
   § 5. Subparagraphs (A) and (B) of paragraph 1  of  subsection  (x)  of
 section 4303 of the insurance law, as amended by chapter 571 of the laws
 of  2022,  are  amended  and  a new subparagraph (C) is added to read as
 follows:
   (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; AND
   (C) PROSTHESES AND PHYSICAL COMPLICATIONS OF ALL STAGES OF MASTECTOMY,
 INCLUDING LYMPHEDEMA;
 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.
   §  6.  Section  4303 of the insurance law is amended by adding two new
 subsections (uu) and (vv) to read as follows:
   (UU) EVERY CONTRACT ISSUED BY A HOSPITAL SERVICE CORPORATION OR HEALTH
 SERVICE CORPORATION WHICH PROVIDES HOSPITAL, SURGICAL, MEDICAL OR  MAJOR
 A. 1876                             5
 
 MEDICAL  COVERAGE  SHALL PROVIDE COVERAGE FOR THE DIFFERENTIAL DIAGNOSIS
 AND TREATMENT OF LYMPHEDEMA,  BOTH  PRIMARY  AND  SECONDARY  LYMPHEDEMA.
 SUCH  COVERAGE  SHALL  INCLUDE,  IN ADDITION TO BENEFITS FOR A COURSE OF
 MANUAL  LYMPH DRAINAGE WHOSE FREQUENCY AND DURATION IS DETERMINED BY THE
 TREATING PHYSICIAN OR THERAPIST BASED ON MEDICAL NECESSITY AND NOT BASED
 ON PHYSICAL THERAPY AND REHABILITATION STANDARDS,  BENEFITS  FOR  EQUIP-
 MENT,  SUPPLIES,  DEVICES, COMPLEX DECONGESTIVE THERAPY, AND OUT-PATIENT
 SELF-MANAGEMENT TRAINING AND EDUCATION FOR THE TREATMENT OF  LYMPHEDEMA,
 IF  PRESCRIBED  BY  A  HEALTH  CARE  PROFESSIONAL  LEGALLY AUTHORIZED TO
 PRESCRIBE OR PROVIDE SUCH ITEMS UNDER TITLE EIGHT OF THE EDUCATION  LAW.
 LYMPHEDEMA THERAPY ADMINISTERED UNDER THIS SECTION SHALL BE ADMINISTERED
 ONLY  BY  A  THERAPIST  CERTIFIED TO PERFORM LYMPHEDEMA TREATMENT BY THE
 LYMPHOLOGY ASSOCIATION OF NORTH AMERICA (LANA) OR CERTIFIED  IN  ACCORD-
 ANCE  WITH  STANDARDS EQUIVALENT TO THE CERTIFICATION STANDARDS OF LANA.
 SUCH EQUIPMENT, SUPPLIES OR DEVICES SHALL INCLUDE, BUT  NOT  BE  LIMITED
 TO,  BANDAGES,  COMPRESSION  GARMENTS, PADS, ORTHOTIC SHOES AND DEVICES,
 WITH REPLACEMENTS WHEN REQUIRED TO MAINTAIN COMPRESSIVE FUNCTION  OR  TO
 ACCOMMODATE  CHANGES  IN  THE  PATIENT'S  DIMENSIONS.  COVERAGE SHALL BE
 PROVIDED FOR FOLLOW-UP TREATMENTS WHEN MEDICALLY REQUIRED OR TO  PERIOD-
 ICALLY VALIDATE HOME TECHNIQUES, TO MONITOR PROGRESS AGAINST THE WRITTEN
 TREATMENT PLAN AND TO MODIFY THE TREATMENT PLAN AS REQUIRED. NO INDIVID-
 UAL,  OTHER  THAN  A LICENSED PHYSICIAN OR SURGEON COMPETENT TO EVALUATE
 THE SPECIFIC CLINICAL ISSUES INVOLVED IN THE CARE  REQUESTED,  MAY  DENY
 REQUESTS  FOR  AUTHORIZATION  OF  HEALTH  CARE SERVICES PURSUANT TO THIS
 SECTION.
   (1) A POLICY WHICH IS A MANAGED HEALTH CARE PRODUCT MAY  REQUIRE  SUCH
 HEALTH  CARE PROFESSIONAL BE A MEMBER OF SUCH MANAGED HEALTH CARE PLAN'S
 PROVIDER NETWORK, PROVIDED THAT SUCH NETWORK INCLUDES SUFFICIENT  HEALTH
 CARE  PROFESSIONALS  WHO ARE QUALIFIED BY SPECIFIC EDUCATION, EXPERIENCE
 AND CREDENTIALS TO  PROVIDE  THE  COVERED  BENEFITS  DESCRIBED  IN  THIS
 SUBSECTION.
   (2)  NO INSURER, CORPORATION, OR HEALTH MAINTENANCE ORGANIZATION SHALL
 IMPOSE UPON ANY PERSON RECEIVING BENEFITS PURSUANT  TO  THIS  SUBSECTION
 ANY  COPAYMENT, FEE, POLICY YEAR OR CALENDAR YEAR, OR DURATIONAL BENEFIT
 LIMITATION OR MAXIMUM FOR BENEFITS  OR  SERVICES  THAT  IS  NOT  EQUALLY
 IMPOSED UPON ALL INDIVIDUALS IN THE SAME BENEFIT CATEGORY.
   (3)  THIS  SUBSECTION  SHALL  NOT APPLY TO SHORT-TERM TRAVEL, ACCIDENT
 ONLY, LIMITED OR SPECIFIED DISEASE, OR INDIVIDUAL CONVERSION POLICIES OR
 CONTRACTS, NOR TO POLICIES OR CONTRACTS DESIGNED FOR ISSUANCE TO PERSONS
 ELIGIBLE FOR COVERAGE UNDER TITLE XVIII  OF  THE  SOCIAL  SECURITY  ACT,
 KNOWN  AS MEDICARE, OR ANY OTHER SIMILAR COVERAGE UNDER STATE OR FEDERAL
 GOVERNMENTAL PLANS.
   (4) FOR PURPOSES OF THIS SUBSECTION, A "MANAGED  CARE  PRODUCT"  SHALL
 MEAN  A POLICY WHICH REQUIRES THAT MEDICAL OR OTHER HEALTH CARE SERVICES
 COVERED UNDER  THE  POLICY,  OTHER  THAN  EMERGENCY  CARE  SERVICES,  BE
 PROVIDED BY, OR PURSUANT TO A REFERRAL FROM A PRIMARY CARE PROVIDER, AND
 THAT  SERVICES  PROVIDED  PURSUANT  TO  SUCH A REFERRAL BE RENDERED BY A
 HEALTH CARE PROVIDER PARTICIPATING IN THE INSURER'S MANAGED CARE PROVID-
 ER NETWORK. IN ADDITION, A MANAGED CARE  PRODUCT  SHALL  ALSO  MEAN  THE
 IN-NETWORK  PORTION  OF  A CONTRACT WHICH REQUIRES THAT MEDICAL OR OTHER
 HEALTH CARE SERVICES COVERED UNDER THE CONTRACT,  OTHER  THAN  EMERGENCY
 CARE  SERVICES, BE PROVIDED BY, OR PURSUANT TO A REFERRAL FROM A PRIMARY
 CARE PROVIDER, AND THAT SERVICES PROVIDED PURSUANT TO SUCH A REFERRAL BE
 RENDERED BY A  HEALTH  CARE  PROVIDER  PARTICIPATING  IN  THE  INSURER'S
 MANAGED  CARE  PROVIDER NETWORK, IN ORDER FOR THE INSURED TO BE ENTITLED
 TO THE MAXIMUM REIMBURSEMENT UNDER THE CONTRACT.
 A. 1876                             6
 
   (VV) PATIENTS UNDERGOING ANY SURGERY OR RADIOTHERAPY  PROCEDURE  SHALL
 BE  PROVIDED  INFORMATION ON THE RISK OF LYMPHEDEMA ASSOCIATED WITH THAT
 PROCEDURE, AND THE  POTENTIAL  POST-PROCEDURE  SYMPTOMS  OF  LYMPHEDEMA.
 INFORMED  CONSENT  AGREEMENTS  FOR ALL SURGERIES AND RADIATION THERAPIES
 SHALL  INCLUDE INFORMATION ON THE RISK OF LYMPHEDEMA ASSOCIATED WITH THE
 ALTERNATIVE PROCEDURES.
   § 7. This act shall take effect on the first of January next  succeed-
 ing  the date on which it shall have become a law and shall apply to all
 insurance policies,  contracts  and  plans  issued,  renewed,  modified,
 altered or amended on or after such effective date.