Introduced Version




SENATE BILL No. 103

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DIGEST OF INTRODUCED BILL



Citations Affected: IC 5-10-8-7.4 ; IC 27-8-14.3 ; IC 27-13-7-14.2 .

Synopsis: Mandatory coverage of annual examinations. Requires group insurance for public employees, group insurers, and health maintenance organizations to provide coverage for annual examinations for a woman who is at least 18 years of age.

Effective: July 1, 2003.



Antich


    January 7, 2003, read first time and referred to Committee on Health and Provider Services.




Introduced

First Regular Session 113th General Assembly (2003)


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.
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SENATE BILL No. 103


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

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

    SECTION 1. IC 5-10-8-7.4 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 7.4. (a) As used in this section, "covered individual" means a woman who is at least eighteen (18) years of age and:
        (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) As used in this section, "annual physical examination" means the following examinations:
        (1) Annual pelvic examination, including a pap smear test.
        (2) Annual breast examination.
        (3) Any other examination commonly included in a gynecological examination.
    (c) A self-insurance program established under section 7(b) of

this chapter to provide health care coverage must provide a covered individual with coverage for an annual physical examination.
    (d) A contract with a health maintenance organization that is entered into or renewed under section 7(c) of this chapter must provide a covered individual with coverage for an annual physical examination.
    (e) The coverage required by subsections (c) and (d) may not be subject to dollar limits, deductibles, 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 with a health maintenance organization.
    (f) The coverage for the annual physical examination required by subsection (c) and the annual physical examination services required by subsection (d) shall be provided in addition to any benefits specifically provided for x-rays, laboratory testing, or wellness examinations.
    SECTION 2. IC 27-8-14.3 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2003]:
     Chapter 14.3. Coverage for Services Related to Annual Examinations
    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) 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, "annual examination" means the following examinations:
        (1) Annual pelvic examination, including a pap smear test.
        (2) Annual breast examination.
        (3) Any other examination commonly included in a gynecological examination.
    Sec. 3. As used in this chapter, "insured" means a female individual who is at least eighteen (18) years of age and who is entitled to coverage under a policy of accident and sickness insurance.
    Sec. 4. (a) An insurer shall provide coverage for annual

examinations in any accident and sickness insurance policy that the insurer issues in Indiana.
    (b) An insured may not be required to pay an annual deductible or coinsurance 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 annual examination benefit required by this chapter.
    (c) 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 the insured than the dollar limits, deductibles, or coinsurance provisions applying to physical illness generally under the accident and sickness insurance policy.
    (d) The coverage that an insurer must provide is in addition to any benefits specifically provided for x-rays, laboratory testing, or wellness examinations.
    SECTION 3. IC 27-13-7-14.2 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 14.2. (a) As used in this section, "annual examination" means the following examinations:
        (1) Annual pelvic examination, including a pap smear test.
        (2) Annual breast examination.
        (3) Any other examination commonly included in a gynecological examination.
    (b) A health maintenance organization issued a certificate of authority in Indiana shall provide to a woman enrollee who is at least eighteen (18) years of age an annual examination as a covered service under every 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 services specifically provided for x-rays, laboratory testing, or wellness examinations.
    SECTION 4. [EFFECTIVE JULY 1, 2003] (a) IC 5-10-8-7.4 , 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, or renewed after June 30, 2003.
    (b) IC 27-8-14.3 , as added by this act, applies to accident and sickness insurance policies that are issued, delivered, or renewed after June 30, 2003.
    (c) IC 27-13-7-14.2 , as added by this act, applies to a health maintenance organization contract that is issued, delivered, or renewed after June 30, 2003.