Salpingectomy Coverage for Cancer Prevention

Summary#

A-11690 would amend New York’s Insurance Law; it would not create a separate law or program. It would require specified health insurers and health maintenance organizations to cover salpingectomy for ovarian cancer prevention, generally without patient cost-sharing. Its stated goal is to require that insurance coverage.

  • The coverage duty would apply to the insurers and plans named in the bill, for policies or contracts issued or delivered in New York.
  • Coverage generally could not have a copayment, coinsurance, or deductible.
  • A high-deductible health plan may apply its deductible to the coverage.
  • The bill would apply to policies and plans issued, renewed, modified, altered, or amended on or after its start date.
  • The bill is at the introduced stage and has been referred to the Assembly Insurance Committee; it is not law.

What it means for you#

  • People with coverage under a plan named in the bill: If it became law and your policy or contract fell under the requirement, your insurer would have to cover salpingectomy for ovarian cancer prevention.
  • People enrolled in a high-deductible health plan: The plan may still require you to pay the deductible for this coverage.
  • Other New Yorkers: The bill does not establish coverage for every type of health plan or every person. It also does not say that every patient would qualify for the procedure.
  • Insurers and health maintenance organizations: They would have to provide the specified coverage for policies or contracts covered by the bill.

Money#

No cost estimate or fiscal information is included in the available material.

  • The bill would require insurers and health maintenance organizations to cover the procedure, usually without copayments, coinsurance, or deductibles. The high-deductible-plan exception would remain.
  • No publicly available information is provided about insurer costs, effects on premiums, or public spending.

What is unclear#

  • The current Insurance Law provisions were not supplied, so it is not possible to verify what coverage or cost-sharing rules already apply.
  • The bill does not define “salpingectomy for ovarian cancer prevention” or set medical eligibility criteria.
  • It does not specify how coverage decisions would be made, or provide timelines, appeals, or reporting rules.
  • The bill does not say how it interacts with coverage requirements under other programs or types of plans.
  • The bill would start on January 1 after it becomes law, but passage is uncertain and no law date is set.

Case for#

  • A possible argument for the bill is that requiring coverage could make the procedure financially accessible to more people with covered plans.
  • Removing copayments, coinsurance, and deductibles for most covered people could reduce direct costs at the time of care.
  • Requiring coverage across the specified policies and contracts could make the coverage requirement clearer and more consistent.

Case against#

  • One concern is that the bill does not define who qualifies or what medical circumstances count as prevention, leaving important coverage details unclear.
  • People with high-deductible plans could still face the deductible, so the bill would not remove all upfront costs for them.
  • Requiring insurers to cover a service could increase their costs; the bill provides no estimate of those costs or any effect on premiums.
  • The bill does not explain how its requirement would fit with existing coverage rules or resolve disagreements over coverage.