Senate Bill No. 73
(By Senators Foster, Klempa and Plymale)
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[Introduced January 13, 2011; referred to the Committee on
Banking and Insurance; and then to the Committee on Finance.]
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A BILL to amend and reenact §5-16-7a of the Code of West Virginia,
1931, as amended; to amend said code by adding thereto a new
section, designated §9-5-21; to amend and reenact §33-15-4f of
said code; to amend and reenact §33-16-3o of said code; to
amend and reenact §33-24-7f of said code; to amend and reenact
§33-25-8e of said code; and to amend and reenact §33-25A-8e of
said code, all relating to requiring insurers to provide
coverage for colorectol screening for individuals fifty years
of age and older.
Be it enacted by the Legislature of West Virginia:
That §5-16-7a of the Code of West Virginia, 1931, as amended,
be amended and reenacted; that said code be amended by adding
thereto a new section, designated §9-5-21; that §33-15-4f of said
code be amended and reenacted; that §33-16-3o of said code be
amended and reenacted; that §33-24-7f of said code be amended and
reenacted; that §33-25-8e of said code be amended and reenacted;
and that §33-25A-8e of said code be amended and reenacted, all to
read as follows:
CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR,
SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD
OF PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS,
OFFICES, PROGRAMS, ETC.
ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-7a. Additional mandated benefits;
required coverage for
colorectal cancer examination and laboratory testing.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement applicable to this article,
reimbursement or indemnification the agency shall provide coverage
for colorectal cancer examinations and laboratory testing
may not
be denied for any for a nonsymptomatic person fifty years of age or
older or a symptomatic person under fifty years of age when
reimbursement or indemnity for laboratory or X ray services are
covered under the policy and are performed for colorectal cancer
screening or diagnostic purposes at the direction of a person
licensed to practice medicine and surgery by the
board of West
Virginia Board of Medicine. The tests
are as follows: An include
an annual fecal occult blood test, a flexible sigmoidoscopy
repeated every five years, a colonoscopy repeated every ten years,
and a double contrast barium enema repeated every five years
or
other test or testing procedure generally accepted by the medical
community.
(b) A symptomatic person is defined as:
(i) (1) An individual who experiences a change in bowel
habits, rectal bleeding or stomach cramps that are persistent; or
(ii) (2) An individual who poses a higher than average risk for colorectal cancer because he or she has had colorectal cancer
or polyps, inflammatory bowel disease or an immediate family
history of such conditions.
(c) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered person may
apply to colorectal cancer examinations and laboratory testing.
CHAPTER 9. HUMAN SERVICES.
ARTICLE 5. MISCELLANEOUS PROVISIONS.
§9-5-21. Required coverage for colorectal cancer examination and
laboratory testing.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement applicable to this article, coverage
shall be provided for colorectal cancer examinations and laboratory
testing for a nonsymptomatic person fifty years of age or older or
a symptomatic person under fifty years of age when performed for
colorectal cancer screening or diagnostic purposes at the direction
of a person licensed to practice medicine and surgery by the West
Virginia Board of Medicine. The tests include an annual fecal
occult blood test, a flexible sigmoidoscopy repeated every five
years, a colonoscopy repeated every ten years, a double contrast
barium enema repeated every five years or other test and testing
procedure generally accepted by the medical community.
(b) A symptomatic person is defined as:
(1) An individual who experiences a change in bowel habits,
rectal bleeding or stomach cramps that are persistent; or
(2) An individual who poses a higher than average risk for colorectal cancer because he or she has had colorectal cancer or
polyps, inflammatory bowel disease or an immediate family history
of such conditions.
(c) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered person may
apply to colorectal cancer examinations and laboratory testing.
CHAPTER 33. INSURANCE.
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-4f.
Required coverage for colorectal cancer examination and
laboratory testing.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement applicable to this article,
reimbursement or indemnification coverage shall be provided for
colorectal cancer examinations and laboratory testing may not be
denied for any for a nonsymptomatic person fifty years of age or
older or a symptomatic person under fifty years of age when
reimbursement or indemnity for laboratory or X ray services are
covered under the policy and are performed for colorectal cancer
screening or diagnostic purposes at the direction of a person
licensed to practice medicine and surgery by the board of West
Virginia Board of Medicine. The tests are as follows: An include
an annual fecal occult blood test, a flexible sigmoidoscopy
repeated every five years, a colonoscopy repeated every ten years,
and a double contrast barium enema repeated every five years or
other test or testing procedure generally accepted by the medical
community.
(b) A symptomatic person is defined as:
(i) (1) An individual who experiences a change in bowel
habits, rectal bleeding or stomach cramps that are persistent; or
(ii) (2) An individual who poses a higher than average risk
for colorectal cancer because he or she has had colorectal cancer
or polyps, inflammatory bowel disease or an immediate family
history of such conditions.
(c) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered person may
apply to colorectal cancer examinations and laboratory testing.
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-3o.
Required coverage for colorectal cancer examination and
laboratory testing.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement applicable to this article,
reimbursement or indemnification coverage shall be provided for
colorectal cancer examinations and laboratory testing may not be
denied for any for a nonsymptomatic person fifty years of age or
older or a symptomatic person under fifty years of age when
reimbursement or indemnity for laboratory or X ray services are
covered under the policy and are performed for colorectal cancer
screening or diagnostic purposes at the direction of a person
licensed to practice medicine and surgery by the board of West
Virginia Board of Medicine. The tests are as follows: An include
an annual fecal occult blood test, a flexible sigmoidoscopy
repeated every five years, a colonoscopy repeated every ten years, and a double contrast barium enema repeated every five years or
other test or testing procedure generally accepted by the medical
community.
(b) A symptomatic person is defined as:
(i) (1) An individual who experiences a change in bowel
habits, rectal bleeding or stomach cramps that are persistent; or
(ii) (2) An individual who poses a higher than average risk
for colorectal cancer because he or she has had colorectal cancer
or polyps, inflammatory bowel disease or an immediate family
history of such conditions.
(c) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered person may
apply to colorectal cancer examinations and laboratory testing.
ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE
CORPORATIONS, DENTAL SERVICE CORPORATIONS AND
HEALTH SERVICE CORPORATIONS.
§33-24-7f.
Required coverage for colorectal cancer examination and
laboratory testing.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement applicable to this article,
reimbursement or indemnification coverage shall be provided for
colorectal cancer examinations and laboratory testing may not be
denied for any for a nonsymptomatic person fifty years of age or
older or a symptomatic person under fifty years of age when
reimbursement or indemnity for laboratory or X ray services are
covered under the policy and are performed for colorectal cancer screening or diagnostic purposes at the direction of a person
licensed to practice medicine and surgery by the board of West
Virginia Board of Medicine. The tests are as follows: An include
an annual fecal occult blood test, a flexible sigmoidoscopy
repeated every five years, a colonoscopy repeated every ten years,
and a double contrast barium enema repeated every five years or
other test or testing procedure generally accepted by the medical
community.
(b) A symptomatic person is defined as:
(i) (1) An individual who experiences a change in bowel
habits, rectal bleeding or stomach cramps that are persistent; or
(ii) (2) An individual who poses a higher than average risk
for colorectal cancer because he or she has had colorectal cancer
or polyps, inflammatory bowel disease or an immediate family
history of such conditions.
(c) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered person may
apply to colorectal cancer examinations and laboratory testing.
ARTICLE 25. HEALTH CARE CORPORATIONS.
§33-25-8e.
Required coverage for colorectal cancer examination and
laboratory testing.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement applicable to this article,
reimbursement or indemnification coverage shall be provided for
colorectal cancer examinations and laboratory testing may not be
denied for any for a nonsymptomatic person fifty years of age or older or a symptomatic person under fifty years of age when
reimbursement or indemnity for laboratory or X ray services are
covered under the policy and are performed for colorectal cancer
screening or diagnostic purposes at the direction of a person
licensed to practice medicine and surgery by the board of West
Virginia Board of Medicine. The tests are as follows: An include
an annual fecal occult blood test, a flexible sigmoidoscopy
repeated every five years, a colonoscopy repeated every ten years,
and a double contrast barium enema repeated every five years or
other test or testing procedure generally accepted by the medical
community.
(b) A symptomatic person is defined as:
(i) (1) An individual who experiences a change in bowel
habits, rectal bleeding or stomach cramps that are persistent; or
(ii) (2) An individual who poses a higher than average risk
for colorectal cancer because he or she has had colorectal cancer
or polyps, inflammatory bowel disease or an immediate family
history of such conditions.
(c) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered person may
apply to colorectal cancer examinations and laboratory testing.
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-8e.
Required coverage for colorectal cancer examination
and laboratory testing.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement applicable to this article, reimbursement or indemnification coverage shall be provided for
colorectal cancer examinations and laboratory testing may not be
denied for any for a nonsymptomatic person fifty years of age or
older or a symptomatic person under fifty years of age when
reimbursement or indemnity for laboratory or X ray services are
covered under the policy and are performed for colorectal cancer
screening or diagnostic purposes at the direction of a person
licensed to practice medicine and surgery by the board of West
Virginia Board of Medicine. The tests are as follows: An include
an annual fecal occult blood test, a flexible sigmoidoscopy
repeated every five years, a colonoscopy repeated every ten years,
and a double contrast barium enema repeated every five years or
other test or testing procedure generally accepted by the medical
community.
(b) A symptomatic person is defined as:
(i) (1) An individual who experiences a change in bowel
habits, rectal bleeding or stomach cramps that are persistent; or
(ii) (2) An individual who poses a higher than average risk
for colorectal cancer because he or she has had colorectal cancer
or polyps, inflammatory bowel disease or an immediate family
history of such conditions.
(c) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered person may
apply to colorectal cancer examinations and laboratory testing.
NOTE: The purpose of this bill is to require health insurance
coverage for colorectal cancer examination and testing for individuals fifty years of age or older.
Strike-throughs indicate language that would be stricken from
the present law and underscoring indicates new language that would
be added.
§9-5-21 is new; therefore, strike-throughs and underscoring
have been omitted.