Title 33, Chapter 30, Section 4.2
( 33-30-4.2)
(a) As used in this Code section, the term: (1) "Female at risk" means a woman: (A) Who has a personal history of breast cancer; (B) Who has a personal history of biopsy proven benign breast
disease; (C) Whose grandmother, mother, sister, or daughter has had
breast cancer; or (D) Who has not given birth prior to age 30. (2) "Mammogram" means any low-dose radiologic screening procedure
for the early detection of breast cancer provided to a woman and
which utilizes equipment approved by the Department of Human
Resources dedicated specifically for mammography and includes a
physician's interpretation of the results of the procedure or
interpretation by a radiologist experienced in mammograms in
accordance with guidelines established by the American College of
Radiology. Reimbursement for a mammogram authorized under this
Code section shall be made only if the facility in which the
mammogram was performed meets accreditation standards established
by the American College of Radiology or equivalent standards
established by this state. Policies subject to this Code section
shall contain coverage for mammograms made with at least the
following frequency: (A) Once as a base-line mammogram for any female who is at least
35 but less than 40 years of age; (B) Once every two years for any female who is at least 40 but
less than 50 years of age; (C) Once every year for any female who is at least 50 years of
age; and (D) When ordered by a physician for a female at risk. (3) "Pap smear" or "Papanicolaou smear" means an examination, in
accordance with standards established by the American College of
Pathologists, of the tissues of the cervix of the uterus for the
purpose of detecting cancer when performed upon the order of a
physician, which examination may be made once a year or more often
if ordered by a physician. (4) "Policy" means any benefit plan, contract, or policy except a
disability income policy, specified disease policy, or hospital
indemnity policy. (5) "Prostate specific antigen test" means a measurement, in
accordance with standards established by the American College of
Pathologists, of a substance produced by the epithelium to
determine if there is any benign or malignant prostate tissue. (b)(1) Every insurer authorized to issue a group accident and
sickness insurance policy in this state which includes coverage
for any female shall include as part of or as a required
endorsement to each such policy which is issued, delivered, issued
for delivery, or renewed on or after July 1, 1992, coverage for
mammograms and Pap smears for the covered females which at least
meets the minimum requirements of this Code section. (2) Every insurer authorized to issue a group accident and
sickness insurance policy in this state which includes coverage
for any male shall include as a part of or as a required
endorsement to each such policy which is issued, delivered, issued
for delivery, or renewed on or after July 1, 1992, coverage for
annual prostate specific antigen tests for the covered males who
are 45 years of age or older or for covered males who are 40 years
of age or older, if ordered by a physician. (c) The coverage required under subsection (b) of this Code section
may be subject to such exclusions, reductions, or other limitations
as to coverages, deductibles, or coinsurance provisions as may be
approved by the Commissioner. (d) Nothing in this Code section shall be construed to prohibit the
issuance of group accident and sickness insurance policies which
provide benefits greater than those required by subsection (b) of
this Code section or more favorable to the insured than those
required by subsection (b) of this Code section. (e) The provisions of this Code section shall apply to group
accident and sickness insurance policies issued by a fraternal
benefit society, a nonprofit hospital service corporation, a
nonprofit medical service corporation, a health care plan, a health
maintenance organization, or any similar entity. (f) Nothing contained in this Code section shall be deemed to
prohibit the payment of different levels of benefits or from having
differences in coinsurance percentages applicable to benefit levels
for services provided by preferred and nonpreferred providers as
otherwise authorized under the provisions of Article 2 of this
chapter, relating to preferred provider arrangements. |