ENGROSSED
COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 516
(By Senators Tomblin, Mr. President, Helmick, Walker, Hunter,
Sprouse, Wooton, Mitchell, Prezioso, McCabe, Craigo, Snyder,
Minard, Kessler, Ross, Anderson, Sharpe, Plymale, Edgell, Ball,
Love, Dawson, Unger, Redd, Bowman and Jackson)
____________
[Originating in the Committee on Banking and Insurance;
reported March 1, 2000.]
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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 sixteen, chapter five of the code of West
Virginia, one thousand nine hundred thirty-one, as amended, be
amended by adding thereto a new section, designated section seven-
a; that article fifteen, chapter thirty-three of said code be
amended by adding thereto a new section, designated section four-f;
that article sixteen of said chapter be amended by adding thereto
a new section, designated section three-o; that article twenty-four
of said chapter be amended by adding thereto a new section,
designated section seven-f; that article twenty-five of said
chapter be amended by adding thereto a new section, designated
section eight-e; and that article twenty-five-a of said chapter be
amended by adding thereto a new section, designated section
eight-e, 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; third party reimbursement
for colorectal cancer examination and laboratory testing.
(a) Notwithstanding any provision of a policy, 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 symptomatic person under fifty years of age,
when reimbursement or indemnity for tests 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.
(b) The tests shall 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.
(c) A symptomatic person is defined as: (1) An individual who
experiences a change in bowel habits, rectal bleeding or persistent
stomach cramps; 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.
(d) 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. Third party reimbursement for colorectal cancer
examination and laboratory testing.
(a) Notwithstanding any provision of a policy, 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 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.
(b) The tests shall 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.
(c) A symptomatic person is defined as: (1) An individual who
experiences a change in bowel habits, rectal bleeding or persistent stomach cramps; 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.
(d) 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 a policy, 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 symptomatic person under fifty years of age,
when reimbursement or indemnity for tests 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.
(b) The tests shall 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.
(c) A symptomatic person is defined as: (1) An individual who
experiences a change in bowel habits, rectal bleeding or persistent
stomach cramps; 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.
(d) 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 a policy, 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 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.
(b) The tests shall 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.
(c) A symptomatic person is defined as: (1) An individual who
experiences a change in bowel habits, rectal bleeding or persistent
stomach cramps; 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.
(d) 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 a policy, 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 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.
(b) The tests shall 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.
(c) A symptomatic person is defined as: (1) An individual who
experiences a change in bowel habits, rectal bleeding or persistent
stomach cramps; 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.
(d) 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 a policy, 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 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.
(b) The tests shall 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.
(c) A symptomatic person is defined as: (1) An individual who
experiences a change in bowel habits, rectal bleeding or persistent
stomach cramps; 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.
(d) 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.
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