ENGROSSED

H. B. 4566


(By Mr. Speaker, Mr. Kiss, and Delegates

Leach, Mezzatesta, Douglas, Trump, Staton and Beane)

[Introduced February 17, 2000; referred to the

Committee on Banking and Insurance then Finance.]




A BILL to amend and reenact section seven, article sixteen, chapter five of the code of West Virginia, one thousand nine hundred thirty-one, as amended; to amend article fifteen, chapter thirty-three of said code by adding thereto a new section, designated section four-f; to amend article sixteen of said chapter by adding thereto a new section, designated section three-o; to amend article twenty-four of said chapter by adding thereto a new section, designated section seven-f; to amend article twenty-five of said chapter by adding thereto a new section, designated section eight-e; and to amend article twenty-five-a of said chapter by adding thereto a new section, designated section eight-e, all relating to requiring insurance companies that provide health care coverage to provide for colorectal cancer examinations and laboratory tests for colorectal cancer.

Be it enacted by the Legislature of West Virginia:
That article fifteen of chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended by adding thereto a new section four-f; that article sixteen of said chapter be amended by adding thereto a new section three-o; and that article twenty-four of said chapter be amended by adding thereto a new section seven-f; that article twenty-five of said chapter be amended by adding thereto a new section eight-e; that article twenty-five-a of said chapter be amended by adding thereto a new section eight-e, all to read as follows:
CHAPTER 33. INSURANCE.
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.

§33-15-4f. Third party reimbursement 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 for colorectal cancer examinations and laboratory testing may not be denied for any 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 medicine. The tests are as follows: an annual fecal occult blood, a flexible sigmoidoscopy repeated every five years, a colonoscopy repeated every ten years, and a double contract barium repeated every five years.
(b) A symptomatic person is defined as: (i) an individual who experiences a change in bowel habits, rectal bleeding or stomach cramps that are persistent, or (ii) 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. Third party reimbursement 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 for colorectal cancer examinations and laboratory testing may not be denied for any 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 medicine. The tests are as follows: an annual fecal occult blood, a flexible sigmoidoscopy repeated every five years, a colonoscopy repeated every ten years, and a double contract barium repeated every five years.
(b) A symptomatic person is defined as: (i) an individual who experiences a change in bowel habits, rectal bleeding or stomach cramps that are persistent, or (ii) 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. Third party reimbursement 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 for colorectal cancer examinations and laboratory testing may not be denied for any 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 medicine. The tests are as follows: an annual fecal occult blood, a flexible sigmoidoscopy repeated every five years, a colonoscopy repeated every ten years, and a double contract barium repeated every five years.
(b) A symptomatic person is defined as: (i) an individual who experiences a change in bowel habits, rectal bleeding or stomach cramps that are persistent, or (ii) 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. Third party reimbursement 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 for colorectal cancer examinations and laboratory testing may not be denied for any 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 medicine. The tests are as follows: an annual fecal occult blood, a flexible sigmoidoscopy repeated every five years, a colonoscopy repeated every ten years, and a double contract barium repeated every five years.
(b) A symptomatic person is defined as: (i) an individual who experiences a change in bowel habits, rectal bleeding or stomach cramps that are persistent, or (ii) 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. Third party reimbursement 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 for colorectal cancer examinations and laboratory testing may not be denied for any 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 medicine. The tests are as follows: an annual fecal occult blood, a flexible sigmoidoscopy repeated every five years, a colonoscopy repeated every ten years, and a double contract barium repeated every five years.
(b) A symptomatic person is defined as: (i) an individual who experiences a change in bowel habits, rectal bleeding or stomach cramps that are persistent, or (ii) 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.