Citations Affected: IC 5-10-8-7.9; IC 27-8-14.9; IC 27-13-7-14.1.
Synopsis: Bone density testing coverage. Requires bone density
testing coverage under certain group health benefit plans.
Effective: July 1, 2005.
January 4, 2005, read first time and referred to Committee on Health and Provider
Services.
A BILL FOR AN ACT to amend the Indiana Code concerning
insurance.
SECTION 1. IC 5-10-8-7.9 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2005]: Sec. 7.9. (a) As used in this section, "bone density testing"
means a radiological or radioisotope procedure or other procedure
that is approved by the federal Food and Drug Administration and
performed for any of the following purposes:
(1) Identifying bone mass.
(2) Detecting bone loss or disease.
(3) Determining bone quality.
(b) As used in this section, "covered individual" means a woman
who is at least forty-five (45) years of age and 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 prepaid health
care delivery plan described in section 7(c) of this chapter.
(c) A self-insurance program established under section 7(b) of
this chapter to provide group health coverage must provide a
covered individual with coverage for bone density testing.
(d) A contract with a prepaid health care delivery plan
described in section 7(c) of this chapter must provide a covered
individual with bone density testing.
(e) The coverage required by subsection (c) and the services
required by subsection (d) may not be subject to dollar limits,
deductibles, copayments, or coinsurance provisions that are less
favorable to a covered individual than the dollar limits,
deductibles, copayments, or coinsurance provisions applying to
physical illness generally under the self-insurance program or
contract.
(f) The coverage required by subsection (c) and the services
required by subsection (d) must be provided in addition to benefits
specifically provided for x-rays, laboratory testing, or wellness
examinations.
SECTION 2. IC 27-8-14.9 IS ADDED TO THE INDIANA CODE
AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2005]:
Chapter 14.9. Coverage for Bone Density Testing
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 kinds of insurance
described in IC 27-1-5-1, Classes 1(b) and 2(a); and
(2) is issued on a group basis.
(b) The term does not include accident only, credit, dental,
vision, Medicare supplement, long term care, or disability income
insurance.
Sec. 2. As used in this chapter, "bone density testing" means a
radiological or radioisotope procedure or other procedure that is
approved by the federal Food and Drug Administration and
performed for any of the following purposes:
(1) Identifying bone mass.
(2) Detecting bone loss or disease.
(3) Determining bone quality.
Sec. 3. As used in this chapter, "insured" means a woman who
is at least forty-five (45) years of age and who is entitled to
coverage under an accident and sickness insurance policy.
Sec. 4. (a) An insurer shall provide an insured with coverage for
bone density testing under any accident and sickness insurance
policy that the insurer issues in Indiana or issues for delivery in
Indiana.
(b) The coverage that an insurer must provide under this
chapter may not be subject to dollar limits, deductibles, or
coinsurance provisions that are less favorable to an insured than
the dollar limits, deductibles, or coinsurance provisions applying
to physical illness generally under the accident and sickness
insurance policy.
(c) The coverage that an insurer must provide under this
chapter is in addition to benefits specifically provided for x-rays,
laboratory testing, or wellness examinations.
SECTION 3. IC 27-13-7-14.1 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2005]: Sec. 14.1. (a) As used in this section,
"bone density testing" means a radiological or radioisotope
procedure or other procedure that is approved by the federal Food
and Drug Administration and performed for any of the following
purposes:
(1) Identifying bone mass.
(2) Detecting bone loss or disease.
(3) Determining bone quality.
(b) A health maintenance organization that is issued a certificate
of authority in Indiana shall provide bone density testing to a
female enrollee who is at least forty-five (45) years of age as a
covered service under a group contract that provides coverage for
basic health care services.
(c) The coverage 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.
(d) The coverage that a health maintenance organization must
provide under this section is in addition to benefits specifically
provided for x-rays, laboratory testing, or wellness examinations.
SECTION 4. [EFFECTIVE JULY 1, 2005] (a) IC 5-10-8-7.9, as
added by this act, applies to a self-insurance program or a contract
with a prepaid health care delivery plan that is established, entered
into, delivered, amended, or renewed after June 30, 2005.
(b) IC 27-8-14.9, as added by this act, applies to an accident and
sickness insurance policy that is issued, delivered, amended, or
renewed after June 30, 2005.
(c) IC 27-13-7-14.1, as added by this act, applies to a health
maintenance organization contract that is entered into, delivered,
amended, or renewed after June 30, 2005.