§ 4095a. Colorectal cancer screening
(a) As used in this section, “colonoscopy” means a procedure that enables a health care
professional to examine visually the inside of a patient’s entire colon and includes
the concurrent removal of polyps or biopsy, or both.
(b) A health insurance plan shall provide coverage for colorectal cancer screening, including:
(1) for a covered individual who is not at high risk for colorectal cancer, colorectal
cancer screening examinations and laboratory tests in accordance with the most recently
published recommendations established by the U.S. Preventive Services Task Force for
average-risk individuals; and
(2) for a covered individual who is at high risk for colorectal cancer, colorectal cancer
screening examinations and laboratory tests as recommended by the treating health
care professional.
(c) For the purposes of subdivision (b)(2) of this section, an individual is at high risk
for colorectal cancer if the individual has:
(1) a family medical history of colorectal cancer or a genetic syndrome predisposing the
individual to colorectal cancer;
(2) a prior occurrence of colorectal cancer or precursor 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 as determined by the individual’s treating health care
professional.
(d) Colorectal cancer screening services performed under contract with the insurer shall
not be subject to any co-payment, deductible, coinsurance, or other cost-sharing requirement.
In addition, a covered individual shall not be subject to any additional charge for
any service associated with a procedure or test for colorectal cancer screening, which
may include one or more of the following:
(1) removal of tissue or other matter;
(2) laboratory services;
(3) health care professional services;
(4) facility use; and
(5) anesthesia. (Recodified and amended 2025, No. 11, § 2, eff. September 1, 2025.)