What's happening
This bill requires health insurance policies in New York to cover genetic testing and related treatments for individuals at significant risk of cancer.
Why it matters
Expands access to cancer prevention and early detection. By requiring insurance to cover genetic testing for those at significant risk, more individuals may be able to identify cancer risk earlier and take preventive or early-intervention measures, potentially improving health outcomes.
Protects against genetic discrimination. The bill explicitly prohibits insurers from denying or canceling coverage based on the results of genetic testing, and forbids using or releasing genetic test results for any other purpose, addressing privacy and discrimination concerns.
Defines who qualifies for coverage. The legislation clarifies that individuals eligible for covered genetic testing are those with significant risk factors, such as a family history of cancer, occurrence in multiple generations, multiple cancers in one family member, or cancer diagnosis in a family member under 45, targeting coverage to those most likely to benefit.
May influence healthcare costs and utilization. While offering important benefits, insurance-mandated genetic testing and follow-up treatments could affect premiums, administrative costs, and demand for genetic counseling and related medical services, with broader implications for the healthcare system.
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Who cares
Patients with a family history of cancer
The bill would require covered policies to pay for genetic testing and subsequent treatment resulting from the test results when an attending physician considers them at significant risk of cancer.
Health insurers
The bill would impose coverage requirements and prohibit denying or cancelling policies based on a predisposing genetic characteristic.
Attending physicians
Their assessment of a patient's cancer risk would help determine eligibility for the mandated genetic testing and treatment coverage.
Patients with inherited genetic risks
The bill would specify that its coverage mandate does not authorize insurers to use or release genetic test results for other purposes.
Headline styles
Require Cancer Genetic Test Coverage
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Referred to insurance
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
4173
2019-2020 Regular Sessions
IN ASSEMBLY
February 1, 2019
Introduced by M. of A. PRETLOW -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to requiring coverage for genetic testing in accident and health insurance policies
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 3216 of the insurance law is amended by adding a new subsection (n) to read as follows:
(n) (1) (A) For purposes of this subsection: "Predisposing genetic characteristic" shall mean any inherited gene or chromosome, or alteration thereof, and determined by a genetic test or inferred from information derived from an individual or family member that is scientifically or medically believed to predispose an individual or the offspring of that individual to a disease or disability, or to be associated with a statistically significant increased risk of the development of a physical or mental disease or disability; and
(B) "Genetic testing" shall mean a test for determining the presence or absence of an inherited genetic characteristic in an individual, including tests of nucleic acids such as DNA, RNA and mitochondrial DNA, chromosomes or proteins in order to identify a predisposing genetic characteristic.
(2) On and after September first, two thousand nineteen every policy delivered or issued for delivery in this state which provides medical coverage that includes coverage for physician services in a physician's office and every policy which provides major medical or similar comprehensive-type coverage shall provide coverage for genetic testing, and any subsequent treatment resulting from the results of such test, of persons who, in the opinion of an attending physician are persons with a significant risk of contracting cancer. For purposes of this section, a person shall be deemed to have a significant risk if there is a family history of cancer, more than one generation in such family has had
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04814-01-9
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cancer, a family member has had more than one occurrence of cancer or a family member less than forty-five years of age has been diagnosed with cancer. Nothing in this subsection shall be deemed to authorize an insurer to utilize or release the results of such test for any other purpose. No policy delivered or issued for delivery in this state pursuant to this article, shall be denied or cancelled on the basis of a predisposing genetic characteristic.
§ 2. Subsection (l) of section 3221 of the insurance law is amended by adding a new paragraph 11-b to read as follows:
(11-b) (A) (i) For purposes of this paragraph: "Predisposing genetic characteristic" shall mean any inherited gene or chromosome, or alteration thereof, and determined by a genetic test or inferred from information derived from an individual or family member that is scientifically or medically believed to predispose an individual or the offspring of that individual to a disease or disability, or to be associated with a statistically significant increased risk of the development of a physical or mental disease or disability; and
(ii) "Genetic testing" shall mean a test for determining the presence or absence of an inherited genetic characteristic in an individual, including tests of nucleic acids such as DNA, RNA and mitochondrial DNA, chromosomes or proteins in order to identify a predisposing genetic characteristic.
(B) On and after September first, two thousand nineteen every policy delivered or issued for delivery in this state which provides medical coverage that includes coverage for physician services in a physician's office and major medical or similar comprehensive-type coverage shall provide coverage for genetic testing, and any subsequent treatment resulting from the results of such test, of persons who, in the opinion of an attending physician are persons with a significant risk of contracting cancer. For purposes of this section, a person shall be deemed to have a significant risk if there is a family history of cancer, more than one generation in such family has had cancer, a family member has had more than one occurrence of cancer or a family member less than forty-five years of age has been diagnosed with cancer. Nothing in this paragraph shall be deemed to authorize an insurer to utilize or release the results of such test for any other purpose. No policy delivered or issued for delivery in this state pursuant to this article, shall be denied or cancelled on the basis of a predisposing genetic characteristic.
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (ss) to read as follows:
(ss) (1) (A) For purposes of this subsection: "Predisposing genetic characteristic" shall mean any inherited gene or chromosome, or alteration thereof, and determined by a genetic test or inferred from information derived from an individual or family member that is scientifically or medically believed to predispose an individual or the offspring of that individual to a disease or disability, or to be associated with a statistically significant increased risk of the development of a physical or mental disease or disability; and
(B) "Genetic testing" shall mean a test for determining the presence or absence of an inherited genetic characteristic in an individual, including tests of nucleic acids such as DNA, RNA and mitochondrial DNA, chromosomes or proteins in order to identify a predisposing genetic characteristic.
(2) On and after September first, two thousand nineteen every policy delivered or issued for delivery in this state which provides medical
A. 4173 3
coverage that includes coverage for physician services in a physician's office or major medical or similar comprehensive-type coverage shall provide coverage for genetic testing, and any subsequent treatment resulting from the results of such test, of persons who, in the opinion of an attending physician are persons with a significant risk of contracting cancer. For purposes of this section, a person shall be deemed to have a significant risk if there is a family history of cancer, more than one generation in such family has had cancer, a family member has had more than one occurrence of cancer or a family member less than forty-five years of age has been diagnosed with cancer. Nothing in this subsection shall be deemed to authorize an insurer to utilize or release the results of such test for any other purpose. No policy delivered or issued for delivery in this state pursuant to this article, shall be denied or cancelled on the basis of a predisposing genetic characteristic.
§ 4. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
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