§ 3555 — Coverage of cancer monitoring and screening tests [For application of this section, see 84 Del. Laws, c. 254, § 4]

Delaware § 3555

• Jurisdiction: Delaware
• Title: 18
• Part: Insurance
• Ch. 35: GROUP AND BLANKET HEALTH INSURANCE
• Subch.: Provisions Applicable to Group and Blanket Health Insurance

Text

(a) All group and blanket health insurance policies, which are delivered or issued for delivery in this State by any health insurer, health service corporation or health maintenance organization, and which provide benefits for outpatient services, shall provide to covered persons residing or having their principal place of employment 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 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)].

(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 or 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, § 2 ; 84 Del. Laws, c. 254, § 2