Provides for mandatory health insurance coverage for coronary artery calcium diagnostic testing upon the recommendation of a health care provider; makes related provisions.
S10480 would require most New York health insurance policies and contracts that provide medical, major medical, or similar comprehensive coverage to cover coronary artery calcium (CAC) diagnostic testing when ordered by a health care provider and supported by nationally recognized clinical practice guidelines for cardiovascular disease prevention. The mandate applies to individual, group, and nonprofit health plans through amendments to the Insurance Law sections governing those policy types.
The bill also prohibits patient cost sharing for covered CAC testing, meaning insurers could not require copayments, coinsurance, or similar out-of-pocket charges for the test. At the same time, it preserves insurer authority to use medical management tools such as utilization review and prior authorization, so long as those controls are consistent with the relevant clinical guidelines. For high-deductible health plans, the bill allows the test to remain subject to the deductible if waiving the deductible would jeopardize the enrollee’s eligibility for a health savings account. The bill would take effect January 1, 2027, and would apply to policies and contracts issued, renewed, modified, altered, or amended on or after that date.
The bill would amend sections 3216, 3221, and 4303 of the Insurance Law to create a new mandatory benefit for coronary artery calcium diagnostic testing across major categories of health coverage in New York. It would expand required insurance benefits, eliminate cost sharing for the test in most cases, and establish a statutory definition of “nationally recognized clinical practice guidelines” for determining when coverage applies. Insurers would retain some utilization review authority, and high-deductible plans would receive a limited exception tied to federal HSA rules. The practical effect would be to broaden access to preventive cardiovascular screening while shifting the cost of the test from patients to insurers, subject to the bill’s exceptions.
Based on the bill text and available context, the measure appears to be framed as a preventive-care expansion with a public health rationale, and there is no recorded committee debate or vote history showing opposition or support. The sponsor’s approach suggests a pro-coverage, pro-screening policy aimed at earlier detection of cardiovascular risk. Because no transcripts or votes are provided, the overall sentiment cannot be measured from legislative discussion, but the bill itself is presented in a straightforward, supportive manner without apparent controversy in the available record.
The main policy tension in the bill is between expanded mandated coverage and insurer cost-control. Supporters would likely emphasize improved access to preventive cardiovascular screening and the elimination of out-of-pocket costs, while insurers may be concerned about the added mandate and utilization of a diagnostic test that could increase claims costs. The bill addresses some of those concerns by allowing medical management and prior authorization, and by carving out an exception for high-deductible health plans where necessary to preserve HSA eligibility. No specific opposition groups or disputed amendments are identified in the available materials.