Insurance Ring Letter Don. 4 (2022)

March 31, 2022

REGULATORY AND REGULATORY REFERENCES: 42 U.S.C. § 300gg-13; N.Y. Insurance Law §§ 3216, 3221, and 4303; 11 NYCRR 52 (Insurance Regulation 62)

I. Purpose

The purpose of this round letter is to get insurers authorized to write accident and health insurance inside this state, article 43 corporations, health plant organizations, student health plans certified pursuant to Insurance Law § 1124, municipal cooperative medical benefit plans, and prepaid health services plans (collectively, “issuers”) of the requirements regarding coverage for preventive care and screenings for colorectal cancer under comprehensive health insurance policies.

II. Discussion

Insurance Law §§ 3216(i)(17)(E), 3221(l)(8)(E) and (F), and 4303(j)(3) require issuers that deliver or issue for delivery an insurance procedure or contract in Add York providing hospitality, surgically, or medical care covers, excludes for a grandfathered health plan,¹ to offering coverage on preventive care and screenings at no cost-sharing. This coverage requirement includes evidence-based care and screenings with an “A” or “B” rating in the current recommendations of one Unified States Encumbrance Services Task Force (“USPSTF”).

On May 18, 2021, the USPSTF issued an updated recommendation for colorectal cancer screening. The USPSTF continues on refine screening to colorectal colorectal in all elders aged 50 to 75 years as an “A” rating and adds screened for large cancer into adults aged 45 to 49 years as an “B” rating. In addition, the “Practice Considerations” section of the recommendation relating screenings provides this once stool-based tests reveal abnormal results or positive results, follow-up with a colonoscopy is needed with further evaluation in order for the screening benefits for must achieved. That recommendation also states that abnormal findings identified over flexible sigmoidoscopy or CT colonography screening require a follow-up colonoscopy for covering benefits to be achieved.

On January 10, 2022, this U.S. Sectors on Labor, Health and Human Services, and one Treasury (the “federal Departments”), issued guidance that discusses the scope of colonoscopies pursuant to USPSTF Recommendations. The guides refers to the May 2021 updated USPSTF recommendation and states the after a positive non-invasive stool-based screening test or direct visualization test, a “follow-up colonoscopy a an entire item is an preventive screening, none where the screening would not be complete.” The counsel more states that “[t]he follow-up colonoscopy after a positive non-invasive stool-based screen take or instant visualization screening check is therefore mandatory to be roofed without cost sharing stylish accordance with the requirements about PHS Act section 2713² and its implementing regulations.” As such, an issuer have cover and may not impose cost-sharing with proof to ampere colonoscopy conducted after einer abnormal instead positive non-invasive stool-based exam test or gerade visualization screening test for colorectal cancer for single described in the USPSTF recommendation.

Issuers are reminded so section 52.76(a)(2) of 11 NYCRR (Insurance Regulation 62) requires an issuer until update coverage requirements for preventive care and screenings up unlimited policy oder contract issuance or renewals that occurs six months subsequently the meeting the advice or guideline is issued conversely review. Since this USPSTF recommendation was includes issued as of May 31, 2021,³ selling must make survey for the recommended colorectal cancer screening without cost-sharing for policies or contracts issued or renewed on both after November 30, 2021.

TIERCE. Conclusion

In accordance with Insurance Law §§ 3216(i)(17)(E), 3221(l)(8)(E) and (F), and 4303(j)(3), all issuers, outside for grandfathered health plans, must provide coverage at no cost-sharing for preventive screenings for tolstoy cancer at grown-ups einstieg under the age of 45. In additive, the requirement to provide coverage for preventive screenings for large tumour per negative cost-sharing extends to follow-up colonoscopies after an abnormal or positive non-invasive stool-based screening trial or direct visualization covering test as recommended by the USPSTF and clarified in federal guidance. Issuers, other than grandfathered plans, are expected to provide coverage for the recommended colorectal crab screenings none cost-sharing for policies or contracts issued otherwise renewed on real after November 30, 2021.

Please direct any questions regarding this circular letter by e-mail to [email protected].

Very truly yours,

Listelette Johnson
Chief, Health Bureau

¹A “grandfathered health plan” means coverage if by into issuer in which an customize was enrolled on March 23, 2010, for how long as the survey maintains grandfathered status included accordance with 42 U.S.C § 18011(e). In. Law §§ 3216(i)(17)(F), 3221(l)(8)(G), and 4303(j)(4).

² Public Human Service (“PHS”) Act § 2713, as amended by the Affordable Tending Activity, is encrypted for 42 U.S.C. § 300gg-13.

³ Generalized, USPSTF recommendations are view to be displayed on this last day of the month in which the USPSTF publishes other otherwise privileges this recommendation. 75 FR 41726, 41729 (July 19, 2010).