WVC 5 - 16 - 7 A
§5-16-7a. Additional mandated benefits; third party reimbursement
for colorectal cancer examination and laboratory
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement applicable to this article,
reimbursement or indemnification for colorectal cancer examinations
and laboratory testing may not be denied for any nonsymptomatic
person fifty years of age or older, or a symptomatic person under
fifty years of age, when reimbursement or indemnity for laboratory
or X ray services are covered under the policy and are performed
for colorectal cancer screening or diagnostic purposes at the
direction of a person licensed to practice medicine and surgery by
the board of medicine. The tests are as follows: An annual fecal
occult blood test, a flexible sigmoidoscopy repeated every five
years, a colonoscopy repeated every ten years and a double contrast
barium enema repeated every five years.
(b) A symptomatic person is defined as: (1) An individual who
experiences a change in bowel habits, rectal bleeding or stomach
cramps that are persistent; or (2) an individual who poses a higher
than average risk for colorectal cancer because he or she has had
colorectal cancer or polyps, inflammatory bowel disease, or an
immediate family history of such conditions.
(c) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered person may apply to colorectal cancer examinations and laboratory testing.
Note: WV Code updated with legislation passed through the 2013 1st Special Session
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