What's happening
This bill expands insurance coverage to include mammograms and other breast cancer diagnostic procedures for individuals with a personal or family history of breast cancer.
Why it matters
Expands insurance coverage to include not only mammograms but also other diagnostic procedures. (like sonograms and advanced imaging) specifically for people with a personal or first-degree family history of breast cancer, which could lead to earlier and more accurate detection for high-risk individuals.
Removes strict age-based limits. (such as coverage for annual mammograms only for those aged 35-39 or 40+) and instead bases coverage on medical history and physician recommendations, making screening more accessible for younger people with relevant risk factors.
Aligns insurance requirements with evidence-based clinical practice guidelines. , meaning coverage is more likely to reflect the latest research and expert recommendations, potentially reducing out-of-pocket costs for necessary screenings.
May help reduce disparities in breast cancer outcomes. by ensuring that high-risk individuals have better access to timely diagnostic tools, regardless of their age, which is especially important for populations where breast cancer can appear earlier or be more aggressive.
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Who cares
People with a personal or first-degree family history of breast cancer
The bill would replace the large-group coverage provision for annual mammograms at ages 35–39 with coverage language addressing their mammograms and breast cancer diagnostic procedures, subject to physician recommendation and insurer medical-necessity review.
People covered by group or blanket insurance policies
The bill would remove the age restriction on a single baseline mammogram and delete the separate requirement for annual mammograms for covered people age 40 and older.
Insurers and health service corporations
The bill would revise their large-group coverage requirements to include language covering sonograms or other diagnostic procedures used to detect breast cancer.
Physicians and breast imaging providers
Their recommendations would remain central to coverage under the revised large-group provision, which would retain insurer review of whether a mammogram is medically necessary.
Headline styles
Expand Breast Cancer Coverage
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Recommit, enacting clause stricken
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
310
2025-2026 Regular Sessions
IN SENATE (Prefiled)
January 8, 2025
Introduced by Sen. RHOADS -- 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 of certain procedures to detect 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 (l) of section 3221 of the insurance law, as amended by chapter 424 of the laws of 2024, 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 thirtynine, inclusive];
(iii) [an annual mammogram, which may be provided by breast tomosynthesis, for covered persons aged forty and older;
(iv)] for large group policies that provide coverage for hospital, surgical or medical care, [an annual mammogram] mammograms for covered persons [aged thirty-five through thirty-nine, inclusive] having a prior history of breast cancer or who have a first degree relative with a prior history of breast cancer, or any sonogram or other diagnostic procedure used to detect breast cancer, upon the recommendation of a physician, subject to the insurer's determination that the mammogram is medically necessary; and
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01242-01-5
[(v)] (iv) upon the recommendation of a physician, screening and diagnostic imaging, including diagnostic mammograms, breast ultrasounds, or magnetic resonance imaging, recommended by nationally recognized clinical practice guidelines for the detection of breast cancer. For the purposes of this item, "nationally recognized clinical practice guidelines" means evidence-based clinical practice guidelines informed by a systematic review of evidence and an assessment of the benefits, and risks of alternative care options intended to optimize patient care developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict of interest policy.
§ 2. Subparagraph (D) of paragraph 1 of subsection (p) of section 4303 of the insurance law, as amended by chapter 424 of the laws of 2024, is amended to read as follows:
(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] mammograms for covered persons [aged thirty-five through thirty-nine, inclusive] having a prior history of breast cancer or who have a first degree relative with a prior history of breast cancer, or any sonogram or other diagnostic procedure used to detect breast cancer, upon the recommendation of a physician, subject to the corporation's determination that the mammogram is medically necessary;
§ 3. This act shall take effect on the same date and in the same manner as chapter 424 of the laws of 2024, takes effect.
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 of certain procedures to detect breast cancer
Summary of provisions
Amends the insurance law in relation to certain procedures to detect breast cancer. Section 1. Subparagraph (A) of paragraph 11 of subsection (1) of section 3221 of the insurance law, as amended by chapter 424 of the laws of 2024, is amended to read as follows: (A) Every insurer delivering a group or blanket policy for delivery in this state and provides coverage for hospital, surgical; or medical care shall provide the following coverage for mammography screening for occult breast cancer.
Justification
New Yorkers are suffering from an increase in breast cancer. Breast Cancer is the most diagnosed cancer among U.S. women. Each year, about 30% of all newly diagnosed cancers in women are breast cancer. Accord- ing to the data from Breatcancer.org, approximately 13% (about one in eight) of U.S. women are going to develop invasive breast cancer during their life.
In New York State breast cancer is one of the most common cancers among women. According to the data from New York Department of Health each year, about 16,700 women are diagnosed with breast cancer, and about 2,500 women die from the disease.
On Long Island, incidents of breast cancer are thirteen to eighteen percent higher than the statewide average, according to The Department of Healthy and Human Services, National Institutes of Health National Cancer Institute, National Institute of Environmental Health Sciences, "REPORT TO THE U.S. CONGRESS THE LONG ISLAND BREAST CANCER STUDY PROJECT November 2004."
This law would give people a fighting chance against this malicious disease. By amending the insurance law, to provide additional viable options at an earlier age for diagnostic testing as determined appropri- ate by a patient's own physicians will lead to earlier diagnosis based upon each patient's unique situation. Cancer is aninsidious malignancy that thrives when hidden. By passing this bill we give the chance for thousands of New Yorkers to find and fight this horrific disease before it takes root.
Effective Date: 30 days after it shall have become law.
Legislative history
New bill.
Fiscal implications
To be determined. 30 days after it shall have become law.
Effective date
30 days 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.