§ 27-13-7-17 — Coverage for colorectal cancer screening; exception for grandfathered health plans

Indiana § 27-13-7-17

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 13: HEALTH MAINTENANCE ORGANIZATIONS
• Ch. 7: Requirements for Group Contracts, Individual Contracts,

Text

(a) As used in this section, "colorectal cancer
testing" means examinations and laboratory tests for cancer for any
nonsymptomatic enrollee.
(b) As used in this section, "follow-up colonoscopy" means a
colonoscopy that is performed as a follow-up to a colorectal cancer
screening test, other than a colonoscopy, that is assigned a grade of "A"
or "B" by the United States Preventive Services Task Force and for
which the result was positive.
(c) Except as provided in subsection (f), a health maintenance
organization issued a certificate of authority in Indiana shall provide
colorectal cancer testing, including:
(1) a colorectal cancer screening test assigned either an "A" or
"B" grade by the United States Preventive Services Task Force;
and
(2) a follow-up colonoscopy;
as a covered service under every group contract that provides coverage
for basic health care services.
(d) For an enrollee who is:
(1) at least forty-five (45) years of age; or
(2) less than forty-five (45) years of age and at high risk for
colorectal cancer;
the colorectal cancer testing required under this section must meet the
requirements set forth in subsection (e), except as provided in
subsection (g).
(e) An enrollee may not be required to pay a copayment for the
colorectal cancer testing benefit required by this section that is greater
than a copayment established for similar benefits under the group
contract under which the enrollee is entitled to services. If the group
contract does not cover a similar covered service, the copayment for the
colorectal cancer testing benefit may not be set at a level that materially
diminishes the value of the colorectal cancer testing benefit.
(f) In the case of coverage that is not employer based, the health
maintenance organization is required only to offer to provide colorectal
cancer testing as a covered service under a proposed group contract
providing coverage for basic health care services.
(g) The requirements imposed under subsection (c)(2) do not apply
to grandfathered health plans as defined in 45 CFR 147.140.

Legislative History

As added by P.L.54-2000, SEC.3. Amended by P.L.1-2001, SEC.34; P.L.124-2018, SEC.90; P.L.36-2020, SEC.3; P.L.165-2022, SEC.13.