New York Mandates Diagnostic Screening for Prostate Cancer with No Cost-Sharing

On Nov. 5, 2018, Gov. Cuomo signed SB S6882A that added to the existing coverage requirement for diagnostic screening of prostate cancer to do so with no cost sharing. Therefore, all New York policies and contracts issued, renewed, modified or amended on and after Jan. 1, 2019 cannot require that diagnostic screening for prostate cancer be subject to annual deductibles or coinsurance.

Under the bill, policies that provide coverage for physician services performed in physicians’ offices, or major medical or similar comprehensive coverage, must provide coverage for diagnostic screening for prostate cancer if prescribed by plan participants’ health care provider.

Specifically, coverage must be provided for:

  • Standard diagnostic testing including, but not limited to, a digital rectal examination and prostate-specific antigen tests at any age for men having a prior history of prostate cancer.
  • An annual standard diagnostic examination including, but not limited to, a digital rectal examination and a prostate-specific antigen test for men age 50 or older and who are asymptomatic and for men age 40 or older with a family history of prostate cancer or other prostate cancer risk factors.

While the bill contains no new employer compliance obligations, employers should be aware of the coverage requirements relating to prostate cancer. Such awareness will help address any employee questions that may arise related to prostate cancer coverage.

Senate Bill S6882A »