On March 31, 2022, the Department of Financial Services (DFS) issued a circular letter to advise health insurers of the coverage requirements for preventive care and screenings for colorectal cancer. The memo follows recent federal guidance based on a recommendation by the United States Preventive Services Task Force (USPSTF).
Excluding grandfathered health plans, insurers that issue or deliver policies in New York providing hospital, surgical, or medical care coverage must provide coverage for 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 USPSTF current recommendations.
The USPSTF updated the recommendation for colorectal cancer screening in May 2021. According to this update, the USPSTF continues to recommend screening for colorectal cancer in all adults aged 50 to 75 years as an “A” rating and adds screening for colorectal cancer in adults aged 45 to 49 years as a “B” rating. Additionally, when stool-based screening tests or direct visualization tests reveal abnormal or positive results, a follow-up with a colonoscopy is needed for further evaluation to achieve the screening benefits. Therefore, based on the updated recommendation, the follow-up colonoscopy must be covered without cost-sharing.
The letter reminds insurers that the updated coverage requirements for preventive care and screenings apply to policies issued or renewed six months after the date a recommendation is issued or revised. Since the USPSTF recommendation was considered issued as of May 31, 2021, insurers must provide coverage for the recommended colorectal cancer screening without cost-sharing for policies or contracts issued or renewed on and after November 30, 2021.
Although the letter is directed at insurers, employers may want to be aware of this coverage requirement.
Insurance Circular Letter 4 (2022): Health Insurance Coverage for the Prevention of Colorectal Cancer | Department of Financial Services »
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