What's happening
Shannon's Law requires large group insurance policies in New York to cover annual mammograms for people aged 35-39 if medically necessary.
Why it matters
Expands access to earlier breast cancer screening. by requiring large group insurance policies to cover annual mammograms for people aged 35-39 when recommended by a physician and deemed medically necessary—potentially allowing for earlier detection in higher-risk individuals.
Targets a gap in insurance coverage. that previously only mandated a single baseline mammogram for those aged 35-39, increasing surveillance frequency for those who may have risk factors or symptoms before age 40.
Limits out-of-pocket costs. by specifying that this coverage cannot be subject to annual deductibles or coinsurance, making medically necessary early screenings more financially accessible.
Puts decision-making in the hands of physicians and insurers. coverage for annual mammograms in this age group is contingent both on a doctor’s recommendation and the insurer’s determination of medical necessity, possibly leading to case-by-case evaluations rather than blanket access.
Albany, before your first meeting.
Every bill that moved yesterday, summarized in a sentence and ranked by impact. The Albany Scorecard follows on Sundays.
Free. Unsubscribe in one click. Want alerts on specific bills? Create an account.
Who cares
People ages 35–39 covered by large group health plans
The bill would require coverage for annual mammograms when recommended by a physician and determined medically necessary by the insurer, beyond the existing single baseline mammogram benefit.
Large group health insurers and health service corporations
They would have to cover the added annual mammograms, subject to their medical necessity determinations.
Physicians treating patients ages 35–39
Their recommendation would be required for patients to receive the added annual mammogram coverage under large group plans.
Headline styles
Expand Mammogram Coverage Age
Plain English, a few words. Used as the page title.
Sponsors
History
- Signed chap.143
- Delivered to governor
- Returned to senate
- Passed assembly
- Ordered to third reading rules cal.268
- Substituted for A5502A
- Referred to ways and means
- Delivered to assembly
- Passed senateVote 62–0
- Amended on third reading 3852a
- Advanced to third reading
- 2nd report cal.
Show 2 earlier actions
- 1st report cal.465
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Expand Mammogram Insurance Coverage
Assembly Floor Calendar · Sponsor Kimberly Jean-Pierre
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3852--A Cal. No. 465
2019-2020 Regular Sessions
IN SENATE
February 20, 2019
Introduced by Sens. MARTINEZ, BOYLE, BROOKS, CARLUCCI, KAMINSKY, MYRIE, RAMOS, SALAZAR, THOMAS -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- reported favorably from said committee, ordered to first and second report, ordered to a third reading, amended and ordered reprinted, retaining its place in the order of third reading
AN ACT to amend the insurance law, in relation to enacting "Shannon's Law"
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Short title. This act shall be known and may be cited as "Shannon's Law".
§ 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 to read as follows:
(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 through thirty-nine, inclusive; [and]
(iii) an annual mammogram, which may be provided by breast tomosynthesis, for covered persons aged forty and older[.]; and
(iv) for large group policies that provide coverage for hospital, surgical or medical care, an annual mammogram for covered persons aged thirty-five through thirty-nine, inclusive, upon the recommendation of a
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD09044-02-9
S. 3852--A 2
physician, subject to the insurer's determination that the mammogram is medically necessary.
§ 3. Subparagraphs (B), (C) and (D) of paragraph 1 of subsection (p) of section 4303 of the insurance law, subparagraphs (B) and (C) as amended by chapter 414 of the laws of 2017, subparagraph (D) as amended by chapter 74 of the laws of 2016, are amended to read as follows:
(B) a single baseline mammogram, which may be provided by breast tomosynthesis, for covered persons aged thirty-five through thirty-nine, inclusive; [and]
(C) an annual mammogram, which may be provided by breast tomosythesis, for covered persons aged forty and older[.];
(D) for large group contracts offered by a medical expense indemnity corporation, a hospital service corporation or a health service corporation that provide coverage for hospital, surgical or medical care, an annual mammogram for covered persons aged thirty-five through thirtynine, inclusive, upon the recommendation of a physician, subject to the corporation's determination that the mammogram is medically necessary; and
(E) The coverage required in this paragraph or paragraph two of this subsection shall not be subject to annual deductibles or coinsurance.
§ 4. This act shall take effect on the thirtieth day after it shall have become a law, and shall apply to policies and contracts issued, renewed, modified, altered or amended on or after such effective 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 enacting "Shannon's Law"
Purpose or general idea of bill
This bill would increase access to annual breast exams for New Yorker's aged thirty-five through thirty-nine.
Summary of provisions
Section 1. Provides that this act shall be known as "Shannon's Law"
Section 2. Amends subparagraph (A) of paragraph 11 of subsection (i) of § 3221 of the insurance law to require large group policy that provides coverage for hospital, surgical, or medical care to provide coverage for an annual mammogram for covered persons aged thirty-five through thir- ty-nine upon the recommendation of a physician, subject to medical necessity.
Section 3. Amends paragraph 1 of subsection (p) of § 4303 of the insur- ance law to require large group contract offered by medical expense indemnity corporation, hospital service corporation or health service corporation that provides coverage for hospital, surgical or medical care to provide coverage for an annual mammogram for covered persons aged thirty-five through thirty-nine upon the recommendation of a physi- cian, subject to medical necessity.
Section 4. Sets forth the effective date.
Difference between original and amended version (if applicable)
Amended bill provides that insurers are required to provide coverage of annual mammograms upon the recommendation of a physician.
Justification
One in 227 women in the U.S. will be diagnosed with breast cancer between the ages of 30 and 40. It is estimated that 13,110 cases of breast cancer will be in women under age 40 and approximately 26,275 women will be under 45 years of age. Women ages 15 to 34 and 35 to 54 die more frequently from breast cancer than other cancer. In Suffolk and Nassau counties alone, there is a new diagnosis every week. We can no longer overlook that this is now an epidemic. Young women generally face more aggressive cancers and lower survival rates. The current informa- tion provided for breast health is not meant for the younger generation. There is a lack of resources regarding this "global crisis" in the curriculum. Revision of the current mammogram age recommendations bene- fits will outweigh the risks. This legislation would give young women the opportunity to seek early detection and the life-saving power of intervention.
Prior legislative history
A.6731-C of 2018
Fiscal implications for state and local governments
None.
Effective date
This act shall take effect the thirtieth day after it shall have become law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.