Reprinted

February 2, 2000






HOUSE BILL No. 1293

_____


DIGEST OF HB 1293 (Updated February 1, 2000 9:22 PM - DI 97)



Citations Affected: IC 5-10; IC 27-8; IC 27-13; noncode.

Synopsis: Colorectal cancer testing. Requires the group self-insurance program for state employees and any contract under which a health maintenance organization (HMO) provides health care services to state employees to provide coverage for colorectal cancer examinations and laboratory tests according to the current guidelines of the American Cancer Society. Requires a group accident and sickness insurance policy to provide coverage for colorectal cancer examinations and laboratory tests according to the current guidelines of the American Cancer Society. Requires a group HMO contract that is employer based to provide colorectal cancer testing as a covered service according to the current guidelines of the American Cancer Society. Provides that an HMO is required only to offer to provide coverage or services for colorectal cancer screenings in the case of group HMO contract that is not employer based.

Effective: July 1, 2000.





Ruppel, Welch, Ayres , Ulmer , Crosby , Duncan , Becker , Budak , Dillon , Kruzan , Goeglein




    January 11, 2000, read first time and referred to Committee on Insurance, Corporations and Small Business.
    January 18, 2000, reported _ Do Pass. Referred to the Committee on Ways and Means, pursuant to Rule 127.
    January 27, 2000, referral to Committee on Ways and Means, pursuant to Rule 127, withdrawn.
    February 1, 2000, read second time, amended, ordered engrossed.







Reprinted

February 2, 2000

Second Regular Session 111th General Assembly (2000)


PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional provision adopted), the text of the new provision will appear in this style type. Also, the word NEW will appear in that style type in the introductory clause of each SECTION that adds a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts between statutes enacted by the 1999 General Assembly.

HOUSE BILL No. 1293



    A BILL FOR AN ACT to amend the Indiana Code concerning insurance.

Be it enacted by the General Assembly of the State of Indiana:

SOURCE: IC 5-10-8-7.7; (00)HB1293.2.1. -->     SECTION 1. IC 5-10-8-7.7 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 7.7. (a) As used in this section, "covered individual" means an individual who is:
        (1) covered under a self-insurance program established under section 7(b) of this chapter to provide group health coverage; or
        (2) entitled to services under a contract with a health maintenance organization (as defined in IC 27-13-1-19) that is entered into or renewed under section 7(c) of this chapter.
    (b) A:
        (1) self-insurance program established under section 7(b) of this chapter to provide health care coverage; or
        (2) contract with a health maintenance organization that is entered into or renewed under section 7(c) of this chapter;
must provide coverage for colorectal cancer examinations and laboratory tests for cancer for any nonsymptomatic covered

individual, in accordance with the current American Cancer Society guidelines.
    (c) For a covered individual who is:
        (1) at least fifty (50) years of age; or
        (2) less than fifty (50) years of age and at high risk for colorectal cancer according to the most recent published guidelines of the American Cancer Society;
the coverage required by this section must meet the requirements set forth in subsection (d).
    (d) A covered individual may not be required to pay an additional deductible and coinsurance for the colorectal cancer examination and laboratory testing benefit that is greater than an annual deductible or coinsurance established for similar benefits under the self insurance program or contract with health maintenance organizations. If the program does not cover a similar benefit, the deductible aor coinsurance may not be set at a level that materially diminishes the value of the colorectal cancer examination and laboratory testing benefic required by this chapter.

SOURCE: IC 27-8-14.8; (00)HB1293.2.2. -->     SECTION 2. IC 27-8-14.8 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]:
     Chapter 14.8. Coverage for Services Related to Colorectal Cancer Screening
    Sec. 1. (a) As used in this chapter, "accident and sickness insurance policy" means an insurance policy that:
        (1) provides at least one (1) of the types of insurance described in IC 27-1-5-1, Classes 1(b) and 2(a); and
        (2) is issued on a group basis.
    (b) "Accident and sickness insurance policy" does not include a policy providing accident only, credit, dental, vision, Medicare supplement, long-term care, or disability income insurance.
    Sec. 2. As used in this chapter, "insured" means an individual who is entitled to coverage under an accident and sickness insurance policy.     Sec. 3. (a) Except as provided in subsection (g), an insurer shall provide coverage for colorectal cancer examinations and laboratory tests for cancer for any nonsymptomatic insured, in accordance with the current American Cancer Society guidelines, in any accident and sickness insurance policy that the insurer issues in Indiana or issues for delivery in Indiana.
    (b) For an insured who is:
        (1) at least fifty (50) years of age; or
        (2) less than fifty (50) years of age and at high risk for colorectal cancer according to the most recent published guidelines of the American Cancer Society;
the coverage required by subsection (a) must meet the requirements set forth in subsection (c).
     (c) An insured may not be required to pay an annual deductible or coinsurance for the colorectal cancer examination and laboratory testing benefit that is greater than an annual deductible or coinsurance established for similar benefits under the accident and sickness insurance policy. If the policy does not cover a similar benefit, the deductible or coinsurance may not be set at a level that materially diminishes the value of the colorectal cancer examination and laboratory testing benefit required by this chapter.

SOURCE: IC 27-13-7-17; (00)HB1293.2.3. -->     SECTION 3. IC 27-13-7-17 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 17. (a) As used in this section, "colorectal cancer testing" means examinations and laboratory tests for cancer for any nonsymptomatic enrollee, in accordance with the current American Cancer Society guidelines.
    (b) Except as provided in subsection (g), a health maintenance organization issued a certificate of authority in Indiana shall provide colorectal cancer testing as a covered service under every group contract that provides coverage for basic health care services.
    (c) For an enrollee who is:
        (1) at least fifty (50) years of age; or
        (2) less than fifty (50) years of age and at high risk for colorectal cancer according to the most recent published guidelines of the American Cancer Society;
the colorectal cancer testing required by subsection (b) must meet the requirements set forth in subsection (d).
    (d) A covered individual may not be required to pay an additional deductible and coinsurance for the colorectal cancer examination and laboratory testing benefit that is greater than an annual deductible or coinsurance established for similar benefits under the self insurance program or contract with health maintenance organizations. If the program does not cover a similar benefit, the deductible aor coinsurance may not be set at a level that materially diminishes the value of the colorectal cancer examination and laboratory testing benefic required by this chapter.
    (e) Except as provided in subsection (g), the colorectal cancer

testing that a health maintenance organization must provide under this section may not be subject to a contract provision that is less favorable to an enrollee than a contract provision applying to physical illness generally under the health maintenance organization contract.     (f) Except as provided in subsection (g), the colorectal cancer testing that a health maintenance organization must provide under this section is in addition to services specifically provided for x-rays, laboratory testing, or wellness examinations.
     (g) In the case of coverage that is not employer based, the health maintenance organization is required only to offer to provide the colorectal cancer testing described in subsections (b) through (f) as a covered service under a proposed group contract providing coverage for basic health care services.

SOURCE: ; (00)HB1293.2.4. -->     SECTION 4. [EFFECTIVE JULY 1, 2000] (a) IC 5-10-8-7.7, as added by this act, applies to a self-insurance program or a contract between the state and a health maintenance organization established, entered into, amended, or renewed after June 30, 2000.
    (b) IC 27-8-14.8, as added by this act, applies to accident and sickness insurance policies that are issued, delivered, amended, or renewed after June 30, 2000.
    (c) IC 27-13-7-17, as added by this act, applies to health maintenance organization contracts that are entered into, amended, or renewed after June 30, 2000.
    (d) This SECTION expires July 1, 2004.