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
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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
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