§ 3338 — Coverage of ovarian cancer monitoring and screening tests [For application of this section, see 84 Del. Laws, c. 254, § 4]

Delaware § 3338

• Jurisdiction: Delaware
• Title: 18
• Part: Insurance
• Ch. 33: HEALTH INSURANCE CONTRACTS
• Subch.: General Provisions

Text

(a) Every individual health, sickness or accident insurance policy, contract or certificate, which is delivered or issued for delivery in this State by any health insurer, health service corporation or health maintenance organization, and which provides benefits for outpatient services, shall provide to covered persons residing in this State a benefit for monitoring tests for ovarian cancer subsequent to treatment and annual screening tests for women at risk for ovarian cancer. Such monitoring or screening tests shall be deemed a covered service. The terms of such coverage, including cost-sharing requirements, shall be no less favorable than the terms of coverage, including cost-sharing requirements, applicable to screening mammography for breast cancer.

(b) This section does not apply to any of the following:

(1) Accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, disability income, or other limited benefit health insurance policies.

(2) A high deductible health plan if providing coverage under subsection (a) of this section would cause the plan to fail to be treated as a high deductible health plan under § 223(c)(2) of the Internal Revenue Code [26 U.S.C. § 223(c)(2)].

(3) A catastrophic health plan if providing coverage under subsection (a) of this section would cause the plan to fail to be treated as a catastrophic plan under § 1302(e) of the Patient Protection and Affordable Care Act, 42 U.S.C. § 18022(e).

(c) If, at any time, the State is required under federal law to defray the cost of any coverage required under this section, the requirements under this section are inoperative and the State does not assume any obligation for the cost of coverage.

(d) For purposes of this section:

(1) “At risk for ovarian cancer” means any of the following:

a. Having a family history of any of the following:

1. One or more first- or second-degree relatives with ovarian cancer.

2. Clusters of women relatives with breast cancer.

3. Nonpolyposis colorectal cancer.

4. Breast cancer in a male relative.

b. Testing positive for any of the following genetic mutations:

1. BRCA1 or BRCA2.

2. Lynch syndrome.

c. Having a personal history of any of the following:

1. Ovarian cancer.

2. Endometriosis.

3. Unexplained infertility.

4. Uterine fibroids.

5. Polycystic ovarian syndrome.

(2) “Cost-sharing requirement” means a deductible, coinsurance, or copayment and any maximum limitation on the application of such a deductible, coinsurance, payment, or similar out-of-pocket expense.

(3) “Monitoring tests” and “screening tests” mean tests and examinations for ovarian cancer using any of the following methods that are recommended by a patient’s physician:

a. Tumor marker tests supported by national clinical guidelines, national standards of care, or peer-reviewed medical literature.

b. Transvaginal ultrasound.

c. Pelvic examination.

d. Other screening tests supported by national clinical guidelines, national standards of care, or peer reviewed medical literature.

Legislative History

69 Del. Laws, c. 405, § 1 ; 80 Del. Laws, c. 310, § 1 ; 84 Del. Laws, c. 254, § 1