House File 550 - Introduced HOUSE FILE BY FORD Passed House, Date Passed Senate, Date Vote: Ayes Nays Vote: Ayes Nays Approved A BILL FOR 1 An Act mandating that certain health insurance policies 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 2597HH 83 6 av/rj/14 PAG LIN 1 1 Section 1. NEW SECTION. 514C.24 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, 2010: 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.24, 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, 2010. 4 16 LSB 2597HH 83 4 17 av/rj/14