STATE OF NEW YORK ________________________________________________________________________ 4029 2025-2026 Regular Sessions IN ASSEMBLY January 30, 2025 ___________ Introduced by M. of A. FALL -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to requiring coverage for colorectal cancer early detection beginning at age thirty-five The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph 11-b of subsection (l) of section 3221 of the 2 insurance law, as amended by chapter 78 of the laws of 2023, is amended 3 to read as follows: 4 (11-b) (A) Every large group policy delivered or issued for delivery 5 in this state which provides medical coverage that includes coverage for 6 physician services in a physician's office and every large group policy 7 which provides major medical or similar comprehensive-type coverage 8 shall provide, upon the prescription of a health care provider acting 9 within the provider's scope of practice pursuant to title eight of the 10 education law, coverage for colorectal cancer preventive screenings in 11 accordance with the American Cancer Society Guidelines for colorectal 12 cancer screening of average risk individuals, except that such coverage 13 shall be provided to all individuals beginning at age thirty-five. The 14 coverage required by this paragraph shall also include coverage for all 15 additional colorectal cancer examinations and laboratory tests recom- 16 mended in accordance with the American Cancer Society Guidelines for 17 colorectal cancer screening of average risk individuals, except that 18 such coverage shall be provided to all individuals beginning at age 19 thirty-five, including an initial colonoscopy or other medical test or 20 procedure for colorectal cancer screening and a follow-up colonoscopy 21 performed as a result of a positive result on a non-colonoscopy preven- 22 tive screening test. A large group policy shall cover colorectal cancer 23 screenings, examinations, and laboratory tests described in this para- 24 graph upon any policy issuance or renewal that occurs six months after 25 the date the guideline described in this paragraph is issued. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD07807-01-5
A. 4029 2 1 (B) An insured shall not be subject to a deductible, coinsurance, or 2 any other cost-sharing requirements for services consistent with subpar- 3 agraph (A) of this paragraph received from participating providers. 4 § 2. Subsection (uu) of section 4303 of the insurance law, as added by 5 chapter 78 of the laws of 2023, is amended to read as follows: 6 (uu) (1) Every large group contract delivered or issued for delivery 7 in this state which provides medical coverage that includes coverage for 8 physician services in a physician's office and every large group 9 contract which provides major medical or similar comprehensive-type 10 coverage shall provide, upon the prescription of a health care provider 11 acting within the provider's scope of practice pursuant to title eight 12 of the education law, coverage for colorectal cancer preventive screen- 13 ings in accordance with the American Cancer Society Guidelines for colo- 14 rectal cancer screening of average risk individuals, except that such 15 coverage shall be provided to all individuals beginning at age thirty- 16 five. The coverage required by this subsection shall also include 17 coverage for all additional colorectal cancer examinations and laborato- 18 ry tests recommended in accordance with the American Cancer Society 19 Guidelines for colorectal cancer screening of average risk individuals, 20 except that such coverage shall be provided to all individuals beginning 21 at age thirty-five, including an initial colonoscopy or other medical 22 test or procedure for colorectal cancer screening and a follow-up colo- 23 noscopy performed as a result of a positive result on a non-colonoscopy 24 preventive screening test. A large group contract shall cover colorectal 25 cancer screenings, examinations, and laboratory tests described in this 26 subsection upon any contract issuance or renewal that occurs six months 27 after the date the guideline described in this subsection is issued. 28 (2) An enrollee shall not be subject to a deductible, coinsurance, or 29 any other cost-sharing requirements for services consistent with para- 30 graph one of this subsection received from participating providers. 31 § 3. Subsection (i) of section 3216 of the insurance law is amended by 32 adding a new paragraph 11-b to read as follows: 33 (11-b) (A) Every policy delivered or issued for delivery in this state 34 which provides medical coverage that includes coverage for physician 35 services in a physician's office and every policy which provides major 36 medical or similar comprehensive-type coverage shall provide, upon the 37 prescription of a health care provider acting within the provider's 38 scope of practice pursuant to title eight of the education law, coverage 39 for colorectal cancer preventive screenings in accordance with the Amer- 40 ican Cancer Society Guidelines for colorectal cancer screening of aver- 41 age risk individuals, except that such coverage shall be provided to all 42 individuals beginning at age thirty-five. The coverage required by this 43 subsection shall also include coverage for all additional colorectal 44 cancer examinations and laboratory tests recommended in accordance with 45 the American Cancer Society Guidelines for colorectal cancer screening 46 of average risk individuals, except that such coverage shall be provided 47 to all individuals beginning at age thirty-five, including an initial 48 colonoscopy or other medical test or procedure for colorectal cancer 49 screening and a follow-up colonoscopy performed as a result of a posi- 50 tive result on a non-colonoscopy preventive screening test. A policy 51 shall cover colorectal cancer screenings, examinations, and laboratory 52 tests described in this subsection upon any policy issuance or renewal 53 that occurs six months after the date the guideline described in this 54 subsection is issued.
A. 4029 3 1 (B) An enrollee shall not be subject to a deductible, coinsurance, or 2 any other cost-sharing requirements for services consistent with subpar- 3 agraph (A) of this paragraph received from participating providers. 4 § 4. Section 339 of the insurance law, as added by chapter 78 of the 5 laws of 2023, is amended to read as follows: 6 § 339. Colorectal cancer screening notification. The superintendent 7 shall require an insurer authorized to write accident and health insur- 8 ance in this state, a corporation organized pursuant to article forty- 9 three of this chapter, and a health maintenance organization certified 10 pursuant to article forty-four of the public health law to notify 11 insureds and enrollees age thirty-five and above at least annually of 12 colorectal cancer screenings covered by such insureds' or enrollees' 13 health insurance policy or contract, and of the most recently published 14 guidelines of the American Cancer Society for colorectal cancer screen- 15 ings that are covered by such insureds' or enrollees' health insurance 16 policy or contract. The notice shall be delivered by United States 17 postal mail unless the insured or enrollee consents to another method of 18 notification, including electronic notification. 19 § 5. This act shall take effect immediately and shall apply to any 20 policy issued, delivered, renewed, and/or modified on or after the 21 effective date of this act.