Requires health insurance coverage for mammography by either mammogram and breast ultrasound or breast tomosynthesis for persons with heterogeneously dense or extremely dense breasts.
Summary
This bill amends New York’s insurance law to expand required health insurance coverage for breast cancer screening. It adds a new coverage option for people with heterogeneously dense or extremely dense breasts: insurers must cover either an annual mammogram plus breast ultrasound, or breast tomosynthesis (3D mammography). The bill applies this requirement across individual, small group, large group, and nonprofit health insurance arrangements, and it ties the new coverage to policies and contracts issued, renewed, modified, altered, or amended on or after the effective date.
The bill also updates existing mammography coverage provisions to align with current screening and diagnostic imaging practices. In addition to the existing age- and risk-based screening requirements, it clarifies coverage for screening and diagnostic imaging recommended by nationally recognized clinical practice guidelines, including diagnostic mammograms, ultrasounds, and MRI when medically recommended. The bill preserves the rule that these mammography-related benefits are not subject to annual deductibles or coinsurance, with a limited high-deductible health plan/HSA-related exception consistent with federal law.
Impact
The bill would amend multiple sections of the Insurance Law, including provisions governing individual policies, group and blanket policies, and nonprofit health service plans. Its practical effect is to require insurers and health plans in New York to cover additional breast cancer screening services for patients with dense breast tissue, thereby broadening mandated benefits and potentially increasing utilization of ultrasound, tomosynthesis, and other diagnostic imaging. It also reinforces that these screenings are generally exempt from deductibles and coinsurance, affecting both insurers’ benefit design and enrollees’ out-of-pocket costs.
Sentiment
The available record shows no committee transcript, vote tally, or formal opposition, so there is no documented debate in the provided materials. Based on the bill’s purpose and caption, the measure appears to be framed as a preventive health coverage expansion aimed at improving breast cancer detection, which typically draws supportive sentiment from patient advocates and health policy proponents. The absence of recorded votes or discussion prevents a more specific assessment of legislative support or resistance.
Contention
The main policy issue is the scope of mandated insurance coverage and the associated cost implications for insurers and potentially premiums. A likely point of contention is whether insurers should be required to cover both mammography plus ultrasound or tomosynthesis for dense breasts, especially given the added utilization and administrative costs. Another possible area of concern is the interaction with high-deductible health plans and federal HSA rules, which the bill addresses by preserving a limited exception. No specific opposing or supporting stakeholders are identified in the provided record.
Same As
Requires health insurance coverage for mammography by either mammogram and breast ultrasound or breast tomosynthesis for persons with heterogeneously dense or extremely dense breasts.
Requires health insurance coverage for mammography by either mammogram and breast ultrasound or breast tomosynthesis for persons with heterogeneously dense or extremely dense breasts.
In casualty insurance, repealing provisions relating to coverage for mammographic examinations and breast imaging and providing for coverage for mammographic examinations, magnetic resonance imaging and other forms of breast imaging.
Requires health care professional to order bi-lateral ultrasounds concurrently when ordering mammograms; requires insurers to cover concurrent mammograms and bi-lateral ultrasounds.
Requires health care professionals to order bi-lateral ultrasounds concurrently when ordering mammograms; requires insurers to cover concurrent mammograms and bi-lateral ultrasounds.