Oklahoma § 36-6060.8 - Prostate cancer screening coverage

§ 36-6060.8. Prostate cancer screening coverage

A. Any health benefit plan that is offered, issued or renewed

in this state on or after January 1, 2000, that provides coverage to

men forty (40) years of age or older in this state shall offer

coverage for annual screening for the early detection of prostate

cancer in men over the age of fifty (50) years and in men over the

Oklahoma Statutes - Title 36. Insurance

age of forty (40) years who are in high-risk categories. The

coverage shall not be subject to policy deductibles. The coverage

shall not exceed the actual cost of the prostate cancer screening up

to a maximum of Sixty-five Dollars ($65.00) per screening.

B. The benefit required to be provided by subsection A of this

section shall in no way diminish or limit diagnostic benefits

otherwise allowable under a health benefit plan.

C. The prostate cancer screening coverage shall be offered as

follows:

1. The screening shall be performed by a qualified medical

professional including, but not limited to, a urologist, internist,

general practitioner, doctor of osteopathy, nurse practitioner, or

physician assistant;

2. The screening shall consist, at a minimum, of the following

tests:

a.

a prostate-specific antigen blood test, and

b.

a digital rectal examination;

3. At least one screening per year shall be covered for any man

fifty (50) years of age or older; and

4. At least one screening per year shall be covered for any man

from forty (40) to fifty (50) years of age who is at increased risk

of developing prostate cancer as determined by a physician.

D. As used in this section, “health benefit plan” means any

plan or arrangement as defined in subsection C of Section 6060.4 of

this title.

Added by Laws 1999, c. 137, § 1, eff. Nov. 1, 1999. Amended by Laws

2003, c. 464, § 8, eff. July 1, 2003; Laws 2010, c. 222, § 38, eff.

Nov. 1, 2010.

NOTE: Editorially renumbered from Title 36, § 6060.7 to avoid a

duplication in numbering.

§36-6060.8a. Colorectal cancer coverage.

A. Any health benefit plan, including the State and Education

Employees Group Health Insurance Plan, that is offered, issued or

renewed in this state on or after January 1, 2002, which provides

medical and surgical benefits, shall offer coverage for colorectal

cancer examinations and laboratory tests for cancer for any

nonsymptomatic covered individual, in accordance with standard,

accepted published medical practice guidelines for colorectal cancer

screening, who is:

1. At least fifty (50) years of age; or

2. Less than fifty (50) years of age and at high risk for

colorectal cancer according to the standard, accepted published

medical practice guidelines.

B. The coverage provided for by this section shall be subject

to the same annual deductibles, co-payments or coinsurance limits as

established for other covered benefits under the health plan.

Oklahoma Statutes - Title 36. Insurance

C. To minimize costs for nonsymptomatic screening, third-party

reimbursement may be at the existing Medicaid rate which shall be

payment in full.

D. As used in this section, “health benefit plan” means any

plan or arrangement as defined in subsection C of Section 6060.4 of

this title; provided, however, the provisions of this section shall

not apply to policies or certificates issued to individuals or to

groups with fifty (50) or fewer employees, or to plans offered under

the state Medicaid program.

Added by Laws 2001, c. 409, § 1, eff. Nov. 1, 2001. Amended by Laws

2010, c. 222, § 39, eff. Nov. 1, 2010.

§36-6060.8b. Coverage for fertility preservation services —

Iatrogenic infertility.

A. As used in this section:

1. “Health benefit plan” means a health benefit plan as defined

pursuant to Section 6060.4 of Title 36 of the Oklahoma Statutes;

2. “Iatrogenic infertility” means an impairment of fertility

caused directly or indirectly by surgery, chemotherapy, radiation,

or other medical treatment with a potential side effect of impaired

fertility as established by the American Society of Clinical

Oncology or the American Society for Reproductive Medicine;

3. “Religious employer” means an employer that is a church,

convention or association of churches, or an elementary or secondary

school that is controlled, operated, or principally supported by a

church or a convention or association of churches as defined

pursuant to Section 3121(w)(3)(A) of the Internal Revenue Code and

that qualifies as a tax-exempt organization under Section 501(c)(3)

of the Internal Revenue Code;

4. “Reproductive age” means the age range in which an

individual is deemed fertile as established by the American Society

of Clinical Oncology and/or the American Society for Reproductive

Medicine; and

5. “Standard fertility preservation services” means oocyte and

sperm preservation procedures, including ovarian tissue, sperm, and

oocyte cryopreservation, that are consistent with established

medical practices or professional guidelines published by the

American Society of Clinical Oncology or the American Society for

Reproductive Medicine; provided, however, standard fertility

preservation services shall not include storage.

B. 1. Any health benefit plan, including the Oklahoma

Employees Insurance Plan, that is offered, issued, or renewed on and

after the effective date of this act shall provide coverage for

standard fertility preservation services, only for individuals

diagnosed with cancer and who are within reproductive age, when a

medically necessary treatment may directly or indirectly cause

iatrogenic infertility.

Oklahoma Statutes - Title 36. Insurance

2. A health benefit plan shall not require preauthorization for

coverage of standard fertility preservation services; however, a

health benefit plan may contain provisions for maximum benefits and

may subject the covered service to the same deductible, copayment,

coinsurance, and reasonable limitations and exclusions to the extent

that these applications are not inconsistent with the provisions of

this section.

C. 1. A religious employer may submit a written request for

exemption to a carrier of a health benefit plan, and such carrier

shall grant the exemption if the coverage required by this section

conflicts with the religious employer’s bona fide religious beliefs

and practices. A religious employer that obtains an exemption

pursuant to this subsection shall provide prospective enrollees of

its health benefit plan with written notice of the exemption.

2. Nothing in this subsection shall prohibit an enrollee of a

health benefit plan provided by his or her religious employer from

purchasing, at his or her own expense, a supplemental insurance

policy that covers standard fertility preservation services.

Added by Laws 2024, c. 349, § 2, eff. Jan. 1, 2025.