Senate Bill No. 1

(By Senator Foster)

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[Introduced January 11, 2012; referred to the Committee on Banking and Insurance; and then to the Committee on Finance.]

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A BILL to amend and reenact §5-16-7a of the Code of West Virginia, 1931, as amended; to amend said code by adding thereto a new section, designated §9-5-22; to amend and reenact §33-15-4f of said code; to amend and reenact §33-16-3o of said code; to amend and reenact §33-24-7f of said code; to amend and reenact §33-25-8e of said code; and to amend and reenact §33-25A-8e of said code, all relating to requiring insurers to provide coverage for colorectal screening for individuals fifty years of age and older.

Be it enacted by the Legislature of West Virginia:

    That §5-16-7a of the Code of West Virginia, 1931, as amended, be amended and reenacted; that said code be amended by adding thereto a new section, designated §9-5-22; that §33-15-4f of said code be amended and reenacted; that §33-16-3o of said code be amended and reenacted; that §33-24-7f of said code be amended and reenacted; that §33-25-8e of said code be amended and reenacted; and that §33-25A-8e of said code be amended and reenacted, all to read as follows:

CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR,

SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD

OF PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS,

OFFICES, PROGRAMS, ETC.

ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.

§5-16-7a. Additional mandated benefits; required coverage for colorectal cancer examination and laboratory testing.

    (a) Notwithstanding any provision of any policy, provision, contract, plan or agreement applicable to this article, reimbursement or indemnification the agency shall provide coverage for colorectal cancer examinations and laboratory testing may not be denied for any for a 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 West Virginia Board of Medicine. The tests are as follows: An include 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 or other test or testing procedure generally accepted by the medical community.

    (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.

CHAPTER 9. HUMAN SERVICES.

ARTICLE 5. MISCELLANEOUS PROVISIONS.

§9-5-22. Required coverage for colorectal cancer examination and laboratory testing.

    (a) Notwithstanding any provision of any policy, provision, contract, plan or agreement applicable to this article, coverage shall be provided for colorectal cancer examinations and laboratory testing for a nonsymptomatic person fifty years of age or older or a symptomatic person under fifty years of age when performed for colorectal cancer screening or diagnostic purposes at the direction of a person licensed to practice medicine and surgery by the West Virginia Board of Medicine. The tests include an annual fecal occult blood test, a flexible sigmoidoscopy repeated every five years, a colonoscopy repeated every ten years, a double contrast barium enema repeated every five years or other test and testing procedure generally accepted by the medical community.

    (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.               CHAPTER 33. INSURANCE.

ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.

§33-15-4f. Required coverage for colorectal cancer examination and laboratory testing.

    (a) Notwithstanding any provision of any policy, provision, contract, plan or agreement applicable to this article, reimbursement or indemnification coverage shall be provided for colorectal cancer examinations and laboratory testing may not be denied for any for a 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 West Virginia Board of Medicine. The tests are as follows: An include 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 or other test or testing procedure generally accepted by the medical community.

    (b) A symptomatic person is defined as:

    (I) (1) An individual who experiences a change in bowel habits, rectal bleeding or stomach cramps that are persistent; or

    (ii) (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.

ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.

§33-16-3o. Required coverage for colorectal cancer examination and laboratory testing.

    (a) Notwithstanding any provision of any policy, provision, contract, plan or agreement applicable to this article, reimbursement or indemnification coverage shall be provided for colorectal cancer examinations and laboratory testing may not be denied for any for a 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 West Virginia Board of Medicine. The tests are as follows: An include 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 or other test or testing procedure generally accepted by the medical community.

    (b) A symptomatic person is defined as:

    (I) (1) An individual who experiences a change in bowel habits, rectal bleeding or stomach cramps that are persistent; or

    (ii) (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.

ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE                  CORPORATIONS, DENTAL SERVICE CORPORATIONS AND                  HEALTH SERVICE CORPORATIONS.

§33-24-7f. Required coverage for colorectal cancer examination and laboratory testing.

    (a) Notwithstanding any provision of any policy, provision, contract, plan or agreement applicable to this article, reimbursement or indemnification coverage shall be provided for colorectal cancer examinations and laboratory testing may not be denied for any for a 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 West Virginia Board of Medicine. The tests are as follows: An include 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 or other test or testing procedure generally accepted by the medical community.

    (b) A symptomatic person is defined as:

    (I) (1) An individual who experiences a change in bowel habits, rectal bleeding or stomach cramps that are persistent; or

    (ii) (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.

ARTICLE 25. HEALTH CARE CORPORATIONS.

§33-25-8e. Required coverage for colorectal cancer examination and laboratory testing.

    (a) Notwithstanding any provision of any policy, provision, contract, plan or agreement applicable to this article, reimbursement or indemnification coverage shall be provided for colorectal cancer examinations and laboratory testing may not be denied for any for a 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 West Virginia Board of Medicine. The tests are as follows: An include 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 or other test or testing procedure generally accepted by the medical community.

    (b) A symptomatic person is defined as:

    (I) (1) An individual who experiences a change in bowel habits, rectal bleeding or stomach cramps that are persistent; or

    (ii) (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.

ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.

§33-25A-8e. Required coverage for colorectal cancer examination and laboratory testing.

    (a) Notwithstanding any provision of any policy, provision, contract, plan or agreement applicable to this article, reimbursement or indemnification coverage shall be provided for colorectal cancer examinations and laboratory testing may not be denied for any for a 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 West Virginia Board of Medicine. The tests are as follows: An include 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 or other test or testing procedure generally accepted by the medical community.

    (b) A symptomatic person is defined as:

    (I) (1) An individual who experiences a change in bowel habits, rectal bleeding or stomach cramps that are persistent; or

    (ii) (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: The purpose of this bill is to require health insurance coverage for colorectal cancer examination and testing for individuals fifty years of age or older.

    Strike-throughs indicate language that would be stricken from the present law and underscoring indicates new language that would be added.

    §9-5-22 is new; therefore, strike-throughs and underscoring have been omitted.