EARLY DETECTION SAVES LIVES APPLICABILITY OF RIGHTS Each year, about 15,000 women in New York are The existing and expanded rights discussed in diagnosed with cancer, and about 2,640 die this brochure are not applicable to self-funded from the disease. Screening for can plans. If you are not sure whether you are increase the detection of the disease at an early covered by a self-funded plan, you should ask stage. Early detection means more cancers will be your employer (or former employer, if you are found at earlier, more treatable stages, and more retired). lives will be saved. This brochure describes existing breast cancer PUBLIC SECTOR EMPLOYERS MUST PROVIDE LEAVE FOR SCREENING screening rights for consumers covered by non- grandfathered policies issued in New York (a non- All public sector employers throughout New grandfathered policy is a policy that was issued after York State are required to provide their March 23, 2010, or a policy issued before that date employees with four hours of leave each year which underwent significant changes to members’ for . benefits or cost share), and new rights under recently passed New York State breast legislation. These new rights will be included in health insurance policies that are issued, renewed, modified or amended on or after January 1, 2017.

IF YOU HAVE QUESTIONS OR WANT TO FILE A COMPLAINT GET SCREENED ON YOUR SCHEDULE The Department of Financial Services ensures that AT A CONVENIENT LOCATION health insurers meet their legal obligations to cover What You Need to Know About... To make it easier for working New Yorkers, breast cancer screening and treatment and works to extended screening hours are now required eliminate any obstacles that New Yorkers and their by law. families may face in the fight against breast cancer. BREAST Text “Get Screened” to 81336, type in your To file a complaint, or if you have questions about CANCER zip code, and get information about this new legislation and whether it applies to you, screening locations near you with extended contact the DFS Consumer Hotline at (800) 342- SCREENING hours. 3736 or visit our website at www.dfs.ny.gov

Including new rights for health insurance This guide is provided for www.dfs.ny.gov policies issued, renewed, modified or informational purposes only and (800) 342-3736 amended on or after January 1, 2017 does not constitute legal advice.  For genetic counseling to individuals whose consultation with the patient, will determine INCREASED ACCESS TO SCREENINGS AND tests reveals positive screening results. If the which type of reconstruction is appropriate. COVERAGE FOR POLICIES ISSUED, RENEWED OR genetic counseling determines specific BRCA The insurance company may not deny the MODIFIED ON OR AFTER JANUARY 1, 2017 testing is appropriate, coverage must be surgery as “not medically necessary.” provided. Under New York State breast cancer legislation, for  Prostheses and physical complications of all health insurance policies and contracts issued,  For medications to reduce breast cancer risk for stages of the , including renewed, modified or amended on or after January individuals at increased risk of breast cancer lymphedemas. The patient’s physician, in 1, 2017, coverage for breast cancer screening and and at low risk for adverse medication effects. consultation with the patient, will determine diagnostic imaging, including diagnostic Such medication must be prescribed by an what treatment is appropriate for the patient’s mammograms, breast ultrasounds, or magnetic appropriate medical professional. condition. The insurance company may review resonance imaging (MRI), must be provided for medical necessity using appropriate written without cost-sharing by the individual. BREAST CANCER TREATMENT clinical criteria based on the most recent AND BREAST RECONSTRUCTION medical literature. Coverage that must be provided without cost- EXISITING RIGHTS sharing includes breast cancer risk assessments, EXPANDED COVERAGE FOR PREVENTATIVE CARE New York –issued health insurance policies must genetic testing, and medications to reduce the risk AND TREATMENT OF BREAST CANCER of breast cancer. provide coverage for: The newly issued guidelines require health insurers  Medically necessary surgeries, including SCREENING AND DIAGNOSTIC IMAGING to eliminate: and prophylactic mastectomies. EXISTING RIGHTS A prophylactic mastectomy is surgery to remove  Annual deductibles. Under existing law, consumers of any age, who one or both to reduce the risk of  Co-payments and co-insurance payments for all have a history of breast cancer or a first degree developing breast cancer. mammograms including those provided to relative with a history of breast cancer, are  Inpatient hospital care following a lymph node individuals more frequently than current covered for an annual mammogram without any dissection or a for as long as is federal screening guidelines (such as annual cost-sharing when a physician recommends it. medically appropriate as determined by the mammograms for women in their forties). attending physician, in consultation with the COVERAGE FOR WOMEN AT INCREASED RISK patient.The insurance company may not deny  Cost-sharing for diagnostic imaging for breast FOR BREAST CANCER, GENETIC SCREENING a hospital stay as “not medically necessary.” The cancer, including diagnostic mammograms, AND MEDICATIONS – EXISTING RIGHTS law states that the patient and their physician breast ultrasounds, and breast MRIs for individuals at high risk for breast cancer. New York-issued health insurance policies that are determine how long the patient needs to non-grandfathered must provide coverage (with remain in the hospital. As a result, policyholders in need of diagnostic tests no cost-sharing requirements):  Breast reconstruction following mastectomy or other than standard annual mammograms will not partial mastectomy, including prophylactic have to pay any additional out-of-pocket expenses.  For primary care providers to screen mastectomy. Coverage includes all stages of Services must be obtained from participating individuals with a family history of breast, reconstruction of the breast which was providers, unless your insurance company does not ovarian, tubal, or peritoneal cancer to identify removed as well as surgery and reconstruction have a provider in their network with the potentially harmful mutations in breast cancer of the other breast to produce a symmetrical appropriate training and experience to meet the susceptibility genes (BRCA1 or BRCA2). appearance. The patient’s physician, in particular health care needs of the policyholder.