House File 2126 - Introduced
HOUSE FILE
BY FOEGE
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act requiring certain health insurance policies to provide
2 coverage for colorectal and prostate cancer screening under
3 some circumstances and providing an applicability date.
4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
5 TLSB 5091HH 81
6 av/sh/8
PAG LIN
1 1 Section 1. NEW SECTION. 514C.23 COLORECTAL AND PROSTATE
1 2 CANCER SCREENING COVERAGE.
1 3 1. Notwithstanding the uniformity of treatment
1 4 requirements of section 514C.6, a policy, contract, or plan
1 5 providing for third=party payment or prepayment of health or
1 6 medical expenses shall provide minimum colorectal cancer
1 7 screening coverage and minimum prostate cancer screening
1 8 coverage, including, but not limited to, the following classes
1 9 of third=party payment provider contracts or policies
1 10 delivered, issued for delivery, continued, or renewed in this
1 11 state:
1 12 a. Individual or group accident and sickness insurance
1 13 providing coverage on an expense=incurred basis.
1 14 b. An individual or group hospital or medical service
1 15 contract issued pursuant to chapter 509, 514, or 514A.
1 16 c. An individual or group health maintenance organization
1 17 contract regulated under chapter 514B.
1 18 d. An individual or group Medicare supplemental policy,
1 19 unless coverage pursuant to such policy is preempted by
1 20 federal law.
1 21 2. This section shall not apply to accident only,
1 22 specified disease, short=term hospital or medical, hospital
1 23 confinement indemnity, credit, dental, vision, Medicare
1 24 supplement, long=term care, basic hospital, and medical=
1 25 surgical expense coverage as defined by the commissioner,
1 26 disability income insurance coverage, coverage issued as a
1 27 supplement to liability insurance, workers' compensation or
1 28 similar insurance, or automobile medical payment insurance.
1 29 3. As used in this section, "minimum colorectal cancer
1 30 screening coverage" means benefits for colorectal examinations
1 31 and laboratory tests for cancer for any nonsymptomatic covered
1 32 individual in accordance with the most recently published
1 33 guidelines of the American cancer society for colorectal
1 34 cancer screening, which are better than or equal to coverage
1 35 for colorectal cancer screening every year for any individual
2 1 who is fifty years of age or older, or for any individual who
2 2 is less than fifty years of age and is at high risk for
2 3 colorectal cancer according to the most recently published
2 4 guidelines of the American cancer society.
2 5 4. As used in this section, "minimum prostate cancer
2 6 screening coverage" means benefits for prostate cancer
2 7 screening examinations including a digital rectal examination
2 8 and a prostate=specific antigen (PSA) or equivalent test for
2 9 the presence of prostate cancer, which are better than or
2 10 equal to coverage for prostate cancer screening every year for
2 11 all men who are fifty years of age or older, and for all men
2 12 less than fifty years of age who are symptomatic or at high
2 13 risk for prostate cancer as determined by the treating
2 14 physician.
2 15 As used in this subsection, "prostate=specific antigen
2 16 (PSA) or equivalent test for the presence of prostate cancer"
2 17 means a seriological test for determining the presence of
2 18 prostate cytoplasmic protein and the generation of antibodies
2 19 to it, as a novel marker for prostatic disease.
2 20 5. The annual deductible or coinsurance for minimum
2 21 colorectal cancer screening coverage or minimum prostate
2 22 cancer screening coverage shall not be greater than the annual
2 23 deductible or coinsurance established for similar benefits
2 24 under the policy, contract, or plan. If the policy, contract,
2 25 or plan does not provide similar benefits, the deductible or
2 26 coinsurance for minimum colorectal cancer screening coverage
2 27 or minimum prostate cancer screening coverage shall not be an
2 28 amount that materially diminishes the value of the required
2 29 coverage.
2 30 6. The commissioner of insurance shall adopt rules under
2 31 chapter 17A as necessary to do all of the following:
2 32 a. Administer the provisions of this section.
2 33 b. Ensure that policies, contracts, or plans that provide
2 34 third=party payment or prepayment of health or medical
2 35 expenses do not include burdensome criteria or other obstacles
3 1 which interfere with access to and provision of the benefits
3 2 required by this section.
3 3 Sec. 2. APPLICABILITY. This Act applies to third=party
3 4 payment provider policies, contracts, or plans that are
3 5 delivered, issued for delivery, continued, or renewed in this
3 6 state on or after January 1, 2007.
3 7 EXPLANATION
3 8 This bill creates new Code section 514C.23, which mandates
3 9 payment of health care costs for minimum colorectal cancer
3 10 screening coverage and minimum prostate cancer screening
3 11 coverage in certain policies, contracts, or plans providing
3 12 for third=party payment or prepayment of health or medical
3 13 expenses. The bill provides that the mandate does not apply
3 14 to certain specified types of insurance coverage.
3 15 The bill defines "minimum colorectal cancer examination
3 16 coverage" as benefits for colorectal examinations and
3 17 laboratory tests for cancer for any nonsymptomatic covered
3 18 individual in accordance with the most recently published
3 19 guidelines of the American cancer society for colorectal
3 20 cancer screening. The covered benefits must, at a minimum,
3 21 provide for annual colorectal cancer screening for any
3 22 individual who is 50 years of age or older or for any
3 23 individual who is less than 50 years old and is at high risk
3 24 for colorectal cancer according to the most recently published
3 25 guidelines of the American cancer society.
3 26 The bill defines "minimum prostate cancer screening
3 27 coverage" to mean benefits for prostate cancer screening
3 28 examinations including a digital rectal examination and a
3 29 prostate=specific antigen (PSA) or equivalent test for the
3 30 presence of prostate cancer. The bill also defines "prostate=
3 31 specific antigen (PSA) or equivalent test for the presence of
3 32 prostate cancer" to mean a seriological test for determining
3 33 the presence of prostate cytoplasmic protein and the
3 34 generation of antibodies to it, as a novel marker for
3 35 prostatic disease.
4 1 The covered benefits also cannot be subject to an annual
4 2 deductible or coinsurance that is greater than that
4 3 established for similar benefits, or if there are no similar
4 4 covered benefits, then the deductible or coinsurance cannot be
4 5 in an amount that materially diminishes the value of the
4 6 required coverage.
4 7 The bill also requires the commissioner of insurance to
4 8 adopt rules under Code chapter 17A as necessary to administer
4 9 the new section and to prevent insurers from adopting
4 10 burdensome criteria or creating other obstacles which
4 11 interfere with access to or provision of the benefits required
4 12 by the new section.
4 13 The new Code section applies to third=party payment
4 14 provider policies, contracts, or plans that are delivered,
4 15 issued for delivery, continued, or renewed in this state on or
4 16 after January 1, 2007.
4 17 LSB 5091HH 81
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