What's happening
This bill expands insurance coverage for breast cancer screening and follow-up diagnostic testing, lowering the starting age and removing cost-sharing for follow-ups.
Why it matters
Broader eligibility for screening. By lowering the starting age for baseline and annual mammograms from 35 and 40 to 25 and 30, respectively, the bill expands early detection to younger adults—important for those with earlier risk or family history.
Reduced financial barriers for follow-up care. The bill requires insurance to cover follow-up diagnostic tests (like biopsies) after an abnormal mammogram without deductibles or coinsurance, which may encourage patients to pursue essential additional testing rather than delay due to costs.
Mandate applies across insurance types. The changes will impact individual, group, and blanket insurance policies, as well as health and hospital service corporations, making the protections widespread and benefiting a larger portion of the population.
Potential impact on breast cancer outcomes. By facilitating earlier detection and ensuring cost is not a barrier for follow-up, the bill could contribute to better health outcomes, less invasive treatments, and potentially higher survival rates for those at risk.
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Who cares
Headline styles
Expand Breast Cancer Screening 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
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2596
2019-2020 Regular Sessions
IN SENATE
January 28, 2019
Introduced by Sen. PARKER -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to coverage for the detection of breast cancer
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subparagraph (A) of paragraph 11 of subsection (i) of section 3216 of the insurance law, as amended by chapter 414 of the laws of 2017, is amended and a new subparagraph (G) is added to read as follows:
(A) Every policy that provides coverage for hospital, surgical or medical care shall provide the following coverage for mammography screening for occult breast cancer:
(i) upon the recommendation of a physician, a mammogram, which may be provided by breast tomosynthesis, at any age for covered persons having a prior history of breast cancer or who have a first degree relative with a prior history of breast cancer;
(ii) a single baseline mammogram, which may be provided by breast tomosynthesis, for covered persons aged [thirty-five] twenty-five through [thirty-nine] twenty-nine, inclusive; and
(iii) an annual mammogram, which may be provided by breast tomosynthesis, for covered persons aged [forty] thirty and older.
(G) Coverage shall also be provided, upon the recommendation of a physician, for follow-up diagnostic testing for the detection of breast cancer, including breast biopsies, in the event that a physician determines that a covered person has had an abnormal mammogram. Such followup diagnostic testing shall not be subject to annual deductibles or coinsurance.
§ 2. Subparagraph (A) of paragraph 11 of subsection (l) of section 3221 of the insurance law, as amended by chapter 414 of the laws of 2017, is amended and a new subparagraph (G) is added to read as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD08326-01-9
S. 2596 2
(A) Every insurer delivering a group or blanket policy or issuing a group or blanket policy for delivery in this state that provides coverage for hospital, surgical or medical care shall provide the following coverage for mammography screening for occult breast cancer:
(i) upon the recommendation of a physician, a mammogram, which may be provided by breast tomosynthesis, at any age for covered persons having a prior history of breast cancer or who have a first degree relative with a prior history of breast cancer;
(ii) a single baseline mammogram, which may be provided by breast tomosynthesis, for covered persons aged [thirty-five] twenty-five through [thirty-nine] twenty-nine, inclusive; and
(iii) an annual mammogram, which may be provided by breast tomosynthesis, for covered persons aged [forty] thirty and older.
(G) Coverage shall also be provided, upon the recommendation of a physician, for follow-up diagnostic testing for the detection of breast cancer, including breast biopsies, in the event that a physician determines that a covered person has had an abnormal mammogram. Such followup diagnostic testing shall not be subject to annual deductibles or coinsurance.
§ 3. Paragraph 1 of subsection (p) of section 4303 of the insurance law, as amended by chapter 219 of the laws of 2011, subparagraphs (A), (B) and (C) as amended by chapter 414 of the laws of 2017 and subparagraph (D) as amended by chapter 74 of the laws of 2016, is amended and a new paragraph 6 is added to read as follows:
(1) A medical expense indemnity corporation, a hospital service corporation or a health service corporation that provides coverage for hospital, surgical or medical care shall provide the following coverage for mammography screening for occult breast cancer:
(A) upon the recommendation of a physician, a mammogram, which may be provided by breast tomosynthesis, at any age for covered persons having a prior history of breast cancer or who have a first degree relative with a prior history of breast cancer;
(B) a single baseline mammogram, which may be provided by breast tomosynthesis, for covered persons aged [thirty-five] twenty-five through [thirty-nine] twenty-nine, inclusive; and
(C) an annual mammogram, which may be provided by breast tomosythesis, for covered persons aged [forty] thirty and older.
(D) The coverage required in this paragraph or paragraph two of this subsection shall not be subject to annual deductibles or coinsurance.
(6) Coverage shall also be provided, upon the recommendation of a physician, for follow-up diagnostic testing for the detection of breast cancer, including breast biopsies, in the event that a physician determines that a covered person has had an abnormal mammogram. Such followup diagnostic testing shall not be subject to annual deductibles or coinsurance.
§ 4. 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.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to coverage for the detection of breast cancer
Purpose
To amend the insurance law to provide coverage for the detection of occult breast cancer in women age thirty and older, and to provide coverage for follow-up diagnostic testing for the detection of breast cancer.
Summary of provisions
Section one requires all hospitals, surgical or medical care facility to provide mammography coverage upon recommendation of a physician, one at any age for a person having a family history of breast cancer or who has a first degree relative with prior history of cancer; baseline screening for women between the ages of twenty-five through thirty-nine, twenty- nine inclusive, and annual mammogram for covered persons aged forty starting at age thirty and older.
Read the full memo (618 words)
Section two requires that every insurer providing coverage for hospital, surgical or medical care shall provide follow-up diagnostic testing for detection of breast cancer, including, biopsies and shall not be subjected to annual deductibles and coinsurance.
Section three amends sub-paragraph D of the laws of 2016 to add, a medical expense indemnity corporation that provides coverage for hospi- tal surgical or medical care shall provide coverage for mammography screening upon recommendation of a physician, a mammography screening for any person at any age for a person having a family history of breast cancer or who has a first degree relative with prior history of cancer; baseline screening for women between the ages of twenty-five through thirty-nine, twenty-nine inclusive, and annual mammogram for covered persons aged forty starting at age thirty
Section four provides effective dates, ninetieth day after it shall become law.
Justification
Breast cancer has been a major crisis among women in the United State (U.S). Statistically, 1 in 8 U.S. women (about 12%) will develop inva- sive breast cancer over the course of her lifetime. In 2018, there was an estimated 266,120 new cases of invasive breast cancer diagnosed in women in the U.S., along with 63,960 new cases of non-invasive breast cancer. In women under 45, breast cancer is more common in African-Amer- ican women than white women. Overall, African-American women are more likely to die of breast cancer. Black women are more likely than other racial/ethnic groups to be diagnosed at later stages and have the lowest survival at each stage of diagnosis.
Continuously, early detection has always been the surest way to prevent death among women diagnosed with breast cancer. In the African American community early detection is tired to access to mammography testing at an earlier age than practiced. In fact, having access to mammograms by age thirty may be the only way to reduce the death rate among women diagnosed with breast cancer.
Even though black women historically had lower breast cancer incidence rates than white women, death rates among black women have historically been higher, and that has continued. In fact, the CDC states that deaths from breast cancer are going down among both black and white women, especially among younger black women. However, breast cancer death rates are 40% higher among black women than white women.
The plain truth is, there are more than 2.8 million women with a history of breast cancer in the U.S. This includes women currently being treated and women who have finished treatment. A woman's risk of breast cancer approximately doubles if she has a first-degree relative who has been diagnosed with breast cancer. Hence, the need to lower the age at which women can receive mammograms to detect early evidence of malignant cell tissues is of paramount importance.
Legislative history
2017-18:S1702- Referred to Insurance
Fiscal implications
Unknown
Effective date
ninetieth day after it shall become law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.