Senate File 2248 - Introduced SENATE FILE BY McKINLEY Passed Senate, Date Passed House, Date Vote: Ayes Nays Vote: Ayes Nays Approved A BILL FOR 1 An Act requiring certain health insurance policies to provide 2 coverage for prostate cancer screening under some 3 circumstances and providing an applicability date. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 5976SS 81 6 av/sh/8 PAG LIN 1 1 Section 1. NEW SECTION. 514C.23 PROSTATE CANCER 1 2 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 prostate cancer 1 7 screening coverage, including, but not limited to, the 1 8 following classes of third=party payment provider contracts or 1 9 policies delivered, issued for delivery, continued, or renewed 1 10 in this state: 1 11 a. Individual or group accident and sickness insurance 1 12 providing coverage on an expense=incurred basis. 1 13 b. An individual or group hospital or medical service 1 14 contract issued pursuant to chapter 509, 509A, 514, or 514A. 1 15 c. An individual or group health maintenance organization 1 16 contract regulated under chapter 514B. 1 17 d. An individual or group Medicare supplemental policy, 1 18 unless coverage pursuant to such policy is preempted by 1 19 federal law. 1 20 2. This section shall not apply to accident only, 1 21 specified disease, short=term hospital or medical, hospital 1 22 confinement indemnity, credit, dental, vision, long=term care, 1 23 basic hospital, and medical=surgical expense coverage as 1 24 defined by the commissioner, disability income insurance 1 25 coverage, coverage issued as a supplement to liability 1 26 insurance, workers' compensation or similar insurance, or 1 27 automobile medical payment insurance. 1 28 3. As used in this section, "minimum prostate cancer 1 29 screening coverage" means benefits for prostate cancer 1 30 screening examinations including a digital rectal examination 1 31 and a prostate=specific antigen (PSA) or equivalent test for 1 32 the presence of prostate cancer, which are better than or 1 33 equal to the following minimum requirements: 1 34 a. Prostate cancer screening every year for all men who 1 35 are fifty years of age or older, and for all men less than 2 1 fifty years of age who are symptomatic or at high risk for 2 2 prostate cancer as determined by the treating physician. 2 3 b. An annual deductible or coinsurance for minimum 2 4 prostate cancer screening coverage that is not greater than 2 5 the annual deductible or coinsurance established for similar 2 6 benefits under the policy, contract, or plan. If the policy, 2 7 contract, or plan does not provide similar benefits, the 2 8 deductible or coinsurance for minimum prostate cancer 2 9 screening coverage shall not be an amount that materially 2 10 diminishes the value of the required coverage. 2 11 As used in this subsection, "prostate=specific antigen 2 12 (PSA) test or equivalent test for the presence of prostate 2 13 cancer" means a seriological test for determining the presence 2 14 of prostate cytoplasmic protein and the generation of 2 15 antibodies to it, as a novel marker for prostatic disease. 2 16 4. The commissioner of insurance shall adopt rules under 2 17 chapter 17A as necessary to do all of the following: 2 18 a. Administer the provisions of this section. 2 19 b. Ensure that policies, contracts, or plans that provide 2 20 third=party payment or prepayment of health or medical 2 21 expenses do not include burdensome criteria or other obstacles 2 22 which interfere with access to and provision of the benefits 2 23 required by this section. 2 24 5. This section applies to third=party payment provider 2 25 policies, contracts, or plans that are delivered, issued for 2 26 delivery, continued, or renewed in this state on or after 2 27 January 1, 2007. 2 28 EXPLANATION 2 29 This bill creates new Code section 514C.23 which mandates 2 30 payment of health care costs for minimum prostate cancer 2 31 screening coverage in certain policies, contracts, or plans 2 32 providing for third=party payment or prepayment of health or 2 33 medical expenses. The bill provides that the mandate does not 2 34 apply to certain specified types of insurance coverage. 2 35 The bill defines "minimum prostate cancer screening 3 1 coverage" to mean benefits for prostate cancer screening 3 2 examinations including a digital rectal examination and a 3 3 prostate=specific antigen (PSA) or equivalent test for the 3 4 presence of prostate cancer. The bill also defines "prostate= 3 5 specific antigen (PSA) test or equivalent test for the 3 6 presence of prostate cancer" to mean a seriological test for 3 7 determining the presence of prostate cytoplasmic protein and 3 8 the generation of antibodies to it, as a novel marker for 3 9 prostatic disease. 3 10 The covered benefits must, at a minimum, provide for annual 3 11 prostate cancer screening for all men who are 50 years of age 3 12 or older, or for all men less than 50 years of age who are 3 13 symptomatic or at high risk for prostate cancer as determined 3 14 by the treating physician. The covered benefits also cannot 3 15 be subject to an annual deductible or coinsurance that is 3 16 greater than that established for similar benefits, or if 3 17 there are no similar covered benefits, then the deductible or 3 18 coinsurance cannot be in an amount that materially diminishes 3 19 the value of the required coverage. 3 20 The bill also requires the commissioner of insurance to 3 21 adopt rules under Code chapter 17A as necessary to administer 3 22 the new section and to prevent insurers from adopting 3 23 burdensome criteria or creating other obstacles which 3 24 interfere with access to or provision of the benefits required 3 25 by the new section. 3 26 The new Code section applies to third=party payment 3 27 provider policies, contracts, or plans that are delivered, 3 28 issued for delivery, continued, or renewed in this state on or 3 29 after January 1, 2007. 3 30 LSB 5976SS 81 3 31 av:nh/sh/8