Requires insurance coverage for the HALO breast pap test to detect risk of developing breast cancer

BILL NUMBER:S5337

Title of bill

An act to amend the insurance law, in relation to coverage for the HALO breast pap test to detect risk of developing breast cancer

Purpose

To require insurance coverage for the HALO breast pap test to detect risk of developing breast cancer.

Summary of provisions

Section 1 amends subsection (i) of section 3216 of the insurance law by adding a new paragraph 27 which requires every policy which provides coverage for hospital, surgical, or medical care coverage also provide coverage for the HALO breast pap test, when such test is recommended by a physician.

Section 2 amends subsection (1) of section 3221 of the insurance law by adding a new paragraph 18 which requires any group or blanket accident or health insurance policy or issuing a group blanket policy for delivery in this state which provides coverage for hospital, surgical, or medical care coverage also provide coverage for the HALO breast pap test, when such test is recommended by a physician.

Section 3 amends section 4303 of the insurance law by adding a new subsection (gg) which requires any medical expense indemnity corporation, hospital service corporation or a health service corporation which provides coverage for hospital, surgical, or medical care coverage also provide coverage for the HALO breast pap test, when such test is recommended by a physician.

Section 4, Effective date.

Justification

HALO is the only FDA-cleared risk assessment tool for non-hereditary breast cancer. By collecting nipple aspirate fluid (NAF) for cytological evaluation, HALO helps identify precancerous changes at the cellular level years before a potentially cancerous lesion might form. Multiple clinical studies concur that women with these cellular abnormalities are four to five times more likely to develop future breast cancer.

One in eight women will develop breast cancer in her lifetime, but to date, ifs been very difficult to identify who is at risk, so we wait for lumps before intervening. Traditional methods of breast cancer screening, mammograms and breast exams, find cancers that have been growing, on average, for eight to ten years. Also, standard film mammography is not as effective in women under 50 with dense breasts, and misses up to 73 percent of cancers in this group, which is one reason for the recent controversy over its use. HALO is a risk assessment tool that can help identify women at greatest risk, years earlier, allowing for earlier intervention and increasing chances for prevention and survival. Knowing who is at greatest risk helps us focus or a limited resources on the right women.

Legislative history

2011-12: A404 referred to Insurance 2009-2010: A10136 held in Insurance/S5894 3rd Reading

Fiscal implications

None,

Effective date

This act shall take effect on the first of January next succeeding the date on which it shall become a law and apply to all policies or contracts issued, renewed, modified, altered or amended on and after such effective date.