Act No. 34

(H.24)

Health; health insurance; coverage; cancer; colorectal; colonoscopy

This act requires health insurers to provide coverage for colorectal cancer screening, including:

(1) Providing insured people 50 years of age or older with the choice of either (A) annual fecal occult blood testing with a flexible sigmoidoscopy every five years or (B) a colonoscopy every 10 years; and

(2) Providing insured people who are at high risk for colorectal cancer with screening examinations and laboratory tests as recommended by the treating physician.

The act requires the health benefits provided to cover the colorectal cancer screening subject to a co-payment no greater than the co-payment that applies to care or services provided by a primary care physician under the insured's policy, not to exceed $100.00, and exempts colorectal cancer screening services from deductible and coinsurance requirements. It also prohibits, if determined to be allowed by the federal Centers for Medicare and Medicaid Services, the out-of-pocket expenditure for a colorectal cancer screening for a patient on Medicare not to exceed $100.00 and requires the hospital or other facility performing the screening to absorb the difference between the Medicare payment and the Medicare rate.

Date Signed by the Governor: May 23, 2009

Effective Date: On passage (May 23, 2009, the date on which the governor signed the bill), except that the coverage requirement takes effect on October 1, 2009 and applies to all health benefit plans offered, issued, or renewed on or after October 1, 2009, but in no event later than October 1, 2010.