Requires health insurance policies to cover comprehensive screening for ovarian cancer

1 Co-sponsor

• Tony Avella

BILL NUMBER:S5373

Title of bill

An act to amend the insurance law, in relation to requiring health insurance policies to cover comprehensive tests for ovarian cancer in certain cases

Purpose or general idea of bill

This bill would require insurance companies to include coverage for screening for ovarian cancer upon the recommendation of a physician.

Summary of specific provisions

Section 1. Paragraph 7 of subsection (d) of section 4326 of the insurance law is amended; Subsection (1) of section 3221 of the insurance law is amended by adding a new paragraph 11-b; Section 4303 of the insurance law is amended by adding a new subsection (p-1) to read the following:

Every policy that provides coverage for hospital, surgical or medical care shall provide the following coverage for screening for ovarian cancer: (i) upon the recommendation of a physician, a pelvic exam, genetic testing, ultrasound and blood testing at any age for covered persons having a high risk of developing ovarian cancer or who have a first degree relative with a prior history of ovarian cancer; (ii) a single baseline ultrasound for covered persons aged thirty-five through thirty-nine, inclusive; and (iii) and an annual ultrasound for covered persons aged forty and older.

(B) Such coverage require pursuant to subparagraph (A) of this paragraph may be subject to annual deductibles and coinsurance as may be deemed appropriate by the superintendent and as are consistent with those established for other benefits within a given policy.

(C) (i) Such policy shall provide for additional coverage for computed tomography, barium enema x-rays, magnetic resonance imaging (MRI), positron emission tomography, laparoscopy, colonoscopy, and biopsy, if a person is believed to be at increased risk for ovarian cancer, positive genetic testing, or other indications as determined by such person's physician or nurse practitioner.

(ii) Such additional coverage may be subject annual deductibles and coinsurance as may be deemed appropriate by the superintendent and as are consistent with those established for other benefits within a given Policy.

Justification

This legislation would help in preventing insurance companies from discriminating against people who have high predispositions to cancer. It will cover the costs of ovarian cancer screening which will lead to early detection and in some cases prevention of life-threatening cancer. According to the American Cancer Society, approximately 22,240 women will be diagnosed with ovarian cancer in 2013 in the United States and 14,020 will lose their battle with ovarian cancer. The cause ovarian cancer remains unknown; however, it is proven that individuals can lower their risks by making certain lifestyle changes. There are many factors that contribute to ovarian cancer that are uncontrollable such as age, race, ethnicity, family history and reproductive history. These characteristics cannot

be modified and therefore are important tools in detecting these signs early include cancer screenings which will lead to early detection and in most cases successful treatment options. This bill will require insurance companies to include cancer screenings in their policies and will save many lives by detecting and treating cancer early.

Prior legislative history

A10526 - 2012, Espinal

Fiscal implications

None known.

Effective date

This act shall take effect on the sixtieth day after it shall have become law.