ENROLLED
COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 516
(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, original sponsors)
____________
[Passed March 11, 2000; in effect ninety days from passage.]
____________
AN ACT to amend article sixteen, chapter five of the code of West
Virginia, one thousand nine hundred thirty-one, as amended, by
adding thereto a new section, designated section seven-a; 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 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 test, a flexible sigmoidoscopy repeated every five
years, a colonoscopy repeated every ten years and a double contrast
barium enema repeated every five years.
(b) A symptomatic person is defined as: (1) An individual who
experiences a change in bowel habits, rectal bleeding or stomach
cramps that are persistent; 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.
(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.
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 test, a flexible sigmoidoscopy repeated every five
years, a colonoscopy repeated every ten years and a double contrast
barium enema 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 test, a flexible sigmoidoscopy repeated every five
years, a colonoscopy repeated every ten years and a double contrast
barium enema 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 test, a flexible sigmoidoscopy repeated every five
years, a colonoscopy repeated every ten years and a double contrast
barium enema 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 test, a flexible sigmoidoscopy repeated every five
years, a colonoscopy repeated every ten years and a double contrast
barium enema 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 test, a flexible sigmoidoscopy repeated every five
years, a colonoscopy repeated every ten years and a double contrast
barium enema 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.