Senate File 191 - Introduced
SENATE FILE
BY BEALL, STEWART, KREIMAN,
RAGAN, DANIELSON, DOTZLER,
DVORSKY, SCHMITZ, DEARDEN,
APPEL, FRAISE, COURTNEY,
GRONSTAL, KIBBIE, BOLKCOM,
QUIRMBACH, McCOY, CONNOLLY,
BLACK, HATCH, SCHOENJAHN,
HECKROTH, and MULDER
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 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 2020XS 82
6 av/es/88
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 on or after January 1, 2008:
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, long=term care,
1 24 basic hospital, and medical=surgical expense coverage as
1 25 defined by the commissioner, disability income insurance
1 26 coverage, coverage issued as a supplement to liability
1 27 insurance, workers' compensation or similar insurance, or
1 28 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 at a minimum provide coverage for
1 35 colorectal cancer screening every year for any individual who
2 1 is fifty years of age or older, or for any individual who is
2 2 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 or equivalent test for the
2 9 presence of prostate cancer, which at a minimum provide
2 10 coverage for prostate cancer screening every year for all men
2 11 who are fifty years of age or older, and for all men less than
2 12 fifty years of age who are symptomatic or at high risk for
2 13 prostate cancer as determined by the treating physician.
2 14 As used in this subsection, "prostate=specific antigen or
2 15 equivalent test for the presence of prostate cancer" means a
2 16 seriological test for determining the presence of prostate
2 17 cytoplasmic protein and the generation of antibodies to it, as
2 18 a novel marker for prostatic disease.
2 19 5. The annual deductible or coinsurance for minimum
2 20 colorectal cancer screening coverage or minimum prostate
2 21 cancer screening coverage shall not be greater than the annual
2 22 deductible or coinsurance established for similar benefits
2 23 under the policy, contract, or plan. If the policy, contract,
2 24 or plan does not provide similar benefits, the deductible or
2 25 coinsurance for minimum colorectal cancer screening coverage
2 26 or minimum prostate cancer screening coverage shall not be an
2 27 amount that materially diminishes the value of the required
2 28 coverage.
2 29 6. The commissioner of insurance shall adopt rules under
2 30 chapter 17A as necessary to do all of the following:
2 31 a. Administer the provisions of this section.
2 32 b. Ensure that policies, contracts, or plans that provide
2 33 third=party payment or prepayment of health or medical
2 34 expenses do not include burdensome criteria or other obstacles
2 35 which interfere with access to and provision of the benefits
3 1 required by this section.
3 2 EXPLANATION
3 3 This bill creates new Code section 514C.23, which mandates
3 4 payment of health care costs for minimum colorectal cancer
3 5 screening coverage and minimum prostate cancer screening
3 6 coverage in certain policies, contracts, or plans providing
3 7 for third=party payment or prepayment of health or medical
3 8 expenses. The bill provides that the mandate does not apply
3 9 to certain specified types of insurance coverage.
3 10 The bill defines "minimum colorectal cancer examination
3 11 coverage" as benefits for colorectal examinations and
3 12 laboratory tests for cancer for any nonsymptomatic covered
3 13 individual in accordance with the most recently published
3 14 guidelines of the American cancer society for colorectal
3 15 cancer screening. The covered benefits must, at a minimum,
3 16 provide for annual colorectal cancer screening for any
3 17 individual who is 50 years of age or older or for any
3 18 individual who is less than 50 years old and is at high risk
3 19 for colorectal cancer according to the most recently published
3 20 guidelines of the American cancer society.
3 21 The bill defines "minimum prostate cancer screening
3 22 coverage" to mean benefits for prostate cancer screening
3 23 examinations including a digital rectal examination and a
3 24 prostate=specific antigen (PSA) or equivalent test for the
3 25 presence of prostate cancer. The covered benefits must, at a
3 26 minimum, provide for annual prostate cancer screening for any
3 27 individual who is 50 years of age or older or for any
3 28 individual who is less than 50 years old and is symptomatic or
3 29 at high risk for prostate cancer as determined by the treating
3 30 physician. The bill also defines "prostate=specific antigen
3 31 (PSA) or equivalent test for the presence of prostate cancer"
3 32 to mean a seriological test for determining the presence of
3 33 prostate cytoplasmic protein and the generation of antibodies
3 34 to it, as a novel marker for prostatic disease.
3 35 The covered benefits also cannot be subject to an annual
4 1 deductible or coinsurance that is greater than that
4 2 established for similar benefits, or if there are no similar
4 3 covered benefits, then the deductible or coinsurance cannot be
4 4 in an amount that materially diminishes the value of the
4 5 required coverage.
4 6 The bill also requires the commissioner of insurance to
4 7 adopt rules under Code chapter 17A as necessary to administer
4 8 the new Code section and to prevent insurers from adopting
4 9 burdensome criteria or creating other obstacles which
4 10 interfere with access to or provision of the benefits required
4 11 by the new Code section.
4 12 The new Code section applies to third=party payment
4 13 provider policies, contracts, or plans that are delivered,
4 14 issued for delivery, continued, or renewed in this state on or
4 15 after January 1, 2008.
4 16 LSB 2020XS 82
4 17 av:rj/es/88