2019 -- S 0679

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LC002095

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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: Senator Maryellen Goodwin

     Date Introduced: March 21, 2019

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

at a minimum:

     (1) Fecal occult blood tests;

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

     (3) Double contrast barium enemas; and

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

has a positive result on any fecal test.

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

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

recommended by the treating physician.

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

colorectal cancer if the individual has:

     (1) A family medical history of colorectal cancer;

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

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

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

     (4) Other predisposing factors.

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

described in 26 U.S.C. 223.

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

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

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

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

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

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

current American Cancer Society guidelines.

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

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

coverage shall include, at a minimum:

     (1) Fecal occult blood tests;

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

     (3) Double contrast barium enemas; and

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

has a positive result on any fecal test.

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

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

recommended by the treating physician.

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

colorectal cancer if the individual has:

     (1) A family medical history of colorectal cancer;

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

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

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

     (4) Other predisposing factors.

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

described in 26 U.S.C. 223.

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

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

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

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

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

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

current American Cancer Society guidelines.

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

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

coverage shall include, at a minimum:

     (1) Fecal occult blood tests;

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

     (3) Double contrast barium enemas; and

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

has a positive result on any fecal test.

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

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

recommended by the treating physician.

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

colorectal cancer if the individual has:

     (1) A family medical history of colorectal cancer;

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

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

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

     (4) Other predisposing factors.

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

described in 26 U.S.C. 223.

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

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Maintenance Organizations" is hereby amended to read as follows:

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

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

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

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

American cancer society guidelines.

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

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

coverage shall include, at a minimum:

     (1) Fecal occult blood tests;

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

     (3) Double contrast barium enemas; and

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

has a positive result on any fecal test.

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

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

recommended by the treating physician.

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

colorectal cancer if the individual has:

     (1) A family medical history of colorectal cancer;

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

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

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

     (4) Other predisposing factors.

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

described in 26 U.S.C. 223.

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

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

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

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

colorectal screening examinations, laboratory tests and colonoscopies covered by health

insurance policies or plans.

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

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

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