Coverage and Copayments for Breast Tomosynthesis

On Feb. 27, 2017, the New York Department of Financial Services published Supplement No. 1 to Insurance Circular Letter No. 2 (2016). The new bulletin relates to health insurance coverage for breast tomosynthesis and prohibitions against copayments and is a supplement to Circular Letter No. 2 (2016), published last year (and covered in our July 26, 2016, edition of Compliance Corner). The bulletin is meant to provide clarification regarding the coverage of tomosynthesis (3D mammograms) and whether the prohibition against annual deductibles and coinsurance for mammography screenings and diagnostic imaging for the detection of breast cancer includes copayments.

The new bulletin clarifies that New York law requires insurers to cover mammography screenings without annual deductibles or coinsurance for policies and contracts issues, renewed, modified or amended on or after Jan. 1, 2017, and that tomosynthesis is a type of mammography screening. The bulletin also clarifies that copayments are a type of coinsurance. Therefore, a carrier must cover tomosynthesis, when medically necessary, without being subject to annual deductibles or coinsurance (including copayments).

The new bulletin contains no new employer obligations, but employers with fully insured plans in New York should review the bulletin to better understand coverage as it relates to breast tomosynthesis.

Supplement No. 1 to Insurance Circular Letter No. 2 (2016) »