2019 -- H 5517

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LC001371

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     

     Introduced By: Representatives Ackerman, Shekarchi, Roberts, Diaz, and Kennedy

     Date Introduced: February 15, 2019

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 27-18-58 of the General Laws in Chapter 27-18 entitled "Accident

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and Sickness Insurance Policies" is hereby amended to read as follows:

3

     27-18-58. Prostate and colorectal examinations -- Coverage mandated.

4

     (a) Every individual or group hospital or accident and sickness insurance policy, medical

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expense insurance policy or individual or group hospital or medical services plan contract

6

delivered, issued for delivery, or renewed in this state shall provide coverage for prostate and

7

colorectal screening examinations and laboratory tests for cancer for any nonsymptomatic person

8

covered under that policy or contract, in accordance with the current American Cancer Society

9

guidelines. Provided, this section does not apply to insurance coverage providing benefits for: (1)

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hospital confinement indemnity; (2) disability income; (3) accident only; (4) long-term care; (5)

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Medicare supplement; (6) limited benefit health; (7) specific disease indemnity; (8) sickness or

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bodily injury or death by accident or both; and (9) other limited benefit policies.

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     (b) If an insured is forty-five (45) years of age or older, an insurer may not impose cost

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sharing on the coverage required by subsection (a) of this section and the coverage shall include,

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at a minimum:

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     (1) Fecal occult blood tests;

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     (2) Colonoscopies, including the removal of polyps during a screening procedure; or

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     (3) Double contrast barium enemas; and

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     (4) A colonoscopy, including the removal of polyps during the procedure, if the insured

 

1

has a positive result on any fecal test.

2

     (c) If an insured is at high risk for colorectal cancer, the coverage required by subsection

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(a) of this section shall include colorectal cancer screening examinations and laboratory tests as

4

recommended by the treating physician.

5

     (d) For the purposes of subsection (c) of this section, an individual is at high risk for

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colorectal cancer if the individual has:

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     (1) A family medical history of colorectal cancer;

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     (2) A prior occurrence of cancer or precursor neoplastic polyps;

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     (3) A prior occurrence of a chronic digestive disease condition such as inflammatory

10

bowel disease, Crohn's disease or ulcerative colitis; or

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     (4) Other predisposing factors.

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     (e) Subsection (b)(4) of this section shall not apply to a high deductible health plan

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described in 26 U.S.C. 223.

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     SECTION 2. Section 27-19-49 of the General Laws in Chapter 27-19 entitled "Nonprofit

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Hospital Service Corporations" is hereby amended to read as follows:

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     27-19-49. Prostate and colorectal examinations -- Coverage mandated.

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     (a) Subscribers to any nonprofit hospital service corporation plan shall be afforded

18

coverage under the plan for prostate and colorectal examinations and laboratory tests for cancer

19

for any nonsymptomatic person covered under the policy or contract plan, in accordance with the

20

current American Cancer Society guidelines.

21

     (b) If an insured is forty-five (45) years of age or older, an insurer or the corporation may

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not impose cost sharing on the coverage required by subsection (a) of this section and the

23

coverage shall include, at a minimum:

24

     (1) Fecal occult blood tests;

25

     (2) Colonoscopies, including the removal of polyps during a screening procedure; or

26

     (3) Double contrast barium enemas; and

27

     (4) A colonoscopy, including the removal of polyps during the procedure, if the insured

28

has a positive result on any fecal test.

29

     (c) If an insured is at high risk for colorectal cancer, the coverage required by subsection

30

(a) of this section shall include colorectal cancer screening examinations and laboratory tests as

31

recommended by the treating physician.

32

     (d) For the purposes of subsection (c) of this section, an individual is at high risk for

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colorectal cancer if the individual has:

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     (1) A family medical history of colorectal cancer;

 

LC001371 - Page 2 of 5

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     (2) A prior occurrence of cancer or precursor neoplastic polyps;

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     (3) A prior occurrence of a chronic digestive disease condition such as inflammatory

3

bowel disease, Crohn's disease or ulcerative colitis; or

4

     (4) Other predisposing factors.

5

     (e) Subsection (b)(4) of this section does not apply to a high deductible health plan

6

described in 26 U.S.C. 223.

7

     SECTION 3. Section 27-20-44 of the General Laws in Chapter 27-20 entitled "Nonprofit

8

Medical Service Corporations" is hereby amended to read as follows:

9

     27-20-44. Prostate and colorectal examinations -- Coverage mandated.

10

     (a) Subscribers to any nonprofit medical service corporation plan shall be afforded

11

coverage under the plan for prostate and colorectal examinations and laboratory tests for cancer

12

for any nonsymptomatic person covered under the policy or contract plan, in accordance with the

13

current American Cancer Society guidelines.

14

     (b) If an insured is forty-five (45) years of age or older, an insurer or the corporation may

15

not impose cost sharing on the coverage required by subsection (a) of this section and the

16

coverage shall include, at a minimum:

17

     (1) Fecal occult blood tests;

18

     (2) Colonoscopies, including the removal of polyps during a screening procedure; or

19

     (3) Double contrast barium enemas; and

20

     (4) A colonoscopy, including the removal of polyps during the procedure, if the insured

21

has a positive result on any fecal test.

22

     (c) If an insured is at high risk for colorectal cancer, the coverage required by subsection

23

(a) of this section shall include colorectal cancer screening examinations and laboratory tests as

24

recommended by the treating physician.

25

     (d) For the purposes of subsection (c) of this section, an individual is at high risk for

26

colorectal cancer if the individual has:

27

     (1) A family medical history of colorectal cancer;

28

     (2) A prior occurrence of cancer or precursor neoplastic polyps;

29

     (3) A prior occurrence of a chronic digestive disease condition such as inflammatory

30

bowel disease, Crohn's disease or ulcerative colitis; or

31

     (4) Other predisposing factors.

32

     (e) Subsection (b)(4) of this section does not apply to a high deductible health plan

33

described in 26 U.S.C. 223.

34

     SECTION 4. Section 27-41-60 of the General Laws in Chapter 27-41 entitled "Health

 

LC001371 - Page 3 of 5

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Maintenance Organizations" is hereby amended to read as follows:

2

     27-41-60. Prostate and colorectal examinations -- Coverage mandated.

3

     (a) Subscribers to any health maintenance organization plan shall be afforded coverage

4

under that plan for prostate and colorectal examinations and laboratory tests for cancer for any

5

nonsymptomatic person covered under the policy or contract plan, in accordance with the current

6

American cancer society guidelines.

7

     (b) If an insured is forty-five (45) years of age or older, an insurer or the organization

8

may not impose cost sharing on the coverage required by subsection (a) of this section and the

9

coverage shall include, at a minimum:

10

     (1) Fecal occult blood tests;

11

     (2) Colonoscopies, including the removal of polyps during a screening procedure; or

12

     (3) Double contrast barium enemas; and

13

     (4) A colonoscopy, including the removal of polyps during the procedure, if the insured

14

has a positive result on any fecal test.

15

     (c) If an insured is at high risk for colorectal cancer, the coverage required by subsection

16

(a) of this section shall include colorectal cancer screening examinations and laboratory tests as

17

recommended by the treating physician.

18

     (d) For the purposes of subsection (c) of this section, an individual is at high risk for

19

colorectal cancer if the individual has:

20

     (1) A family medical history of colorectal cancer;

21

     (2) A prior occurrence of cancer or precursor neoplastic polyps;

22

     (3) A prior occurrence of a chronic digestive disease condition such as inflammatory

23

bowel disease, Crohn's disease or ulcerative colitis; or

24

     (4) Other predisposing factors.

25

     (e) Subsection (b)(4) of this section does not apply to a high deductible health plan

26

described in 26 U.S.C. 223.

27

     SECTION 5. This act shall take effect upon passage and shall apply to policies or plans

28

delivered, issued for delivery or renewed in this state on and after September 1, 2019.

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LC001371

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LC001371 - Page 4 of 5

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

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     This act would prohibit cost sharing for persons forty-five (45) years or older for

2

colorectal screening examinations, laboratory tests and colonoscopies covered by health

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insurance policies or plans.

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     This act would take effect upon passage and would apply to policies or plans delivered,

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issued for delivery or renewed in this state on and after September 1, 2019.

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LC001371

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LC001371 - Page 5 of 5