July 8, 2016
Contact: Richard Loconte, 212-709-1691
DFS SUPERINTENDENT VULLO ANNOUNCES ACTION TO EXPAND HEALTH INSURANCE COVERAGE FOR PREVENTATIVE CARE AND TREATMENT OF BREAST CANCER
DFS’s action follows groundbreaking legislation recently signed by Governor Cuomo to increase access to breast cancer screenings and health insurance coverage.
Following groundbreaking legislation recently signed by Governor Andrew M. Cuomo to increase access to breast cancer screenings and health insurance coverage, Financial Services Superintendent Maria T. Vullo today announced that the Department of Financial Services (DFS) has issued guidance to inform health insurers that they must provide coverage with no cost-sharing for breast cancer screenings, breast cancer risk assessments, genetic testing, and medications to reduce the risk of breast cancer. DFS’s action builds on the series of breast cancer initiatives outlined in the Governor’s 2016 State of the State address.
“DFS is proud to implement Governor Cuomo’s groundbreaking legislation and initiatives to provide women with the life-saving breast cancer early detection services they need,” said Financial Services Superintendent Maria T. Vullo. “The cost of important preventative measures, such as mastectomies and mammograms, should not be a barrier in the fight to save the lives of women and families across New York State. DFS will ensure that health insurers meet their legal obligations to cover breast cancer screening and treatment and eliminate any obstacles women and their families may face in the fight against breast cancer.”
The new guidance issued today requires health insurers to eliminate annual deductibles, co-payments, and co-insurance payments for all mammograms, including those provided to women more frequently than current federal screening guidelines such as annual mammograms for women in their forties. It also eliminates cost-sharing for diagnostic imaging for breast cancer, including diagnostic mammograms, breast ultrasounds, and breast MRIs for women at high risk for breast cancer. As a result, women in need of tests other than standard mammograms will not have to pay any additional out-of-pocket expenses for these most common diagnostic tests.
By today’s action, DFS also reminds health insurers that provide surgical or medical care for mastectomies of their existing obligations to provide coverage for all stages of breast reconstruction, of the breast on which the mastectomy has been performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and physical complications of all stages of the mastectomy.
In addition, insurers are required to provide coverage, with no cost-sharing, to women who are at increased risk for breast cancer for primary care providers to screen women who have family members with breast, ovarian, tubal, or peritoneal cancer with one of several screening tools designed to identify a family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes; to women who have positive screening results pursuant to the above-described screening for genetic counseling and, if indicated after counseling, BRCA testing; and for breast cancer risk reducing medications prescribed by a clinician to women who are at increased risk of breast cancer and at low risk for adverse medication effects.
A copy of the NYDFS letter sent to insurers can be viewed here. The recent announcement by Governor Cuomo announcing the signing of the legislation to increase access to breast cancer screenings can be found here.