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

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

Sec. 17. (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.

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.