Sponsored by:
Senator TROY SINGLETON
District 7 (Burlington)
Co-Sponsored by:
Senator Gopal
SYNOPSIS
Expands requirements for health insurance carriers concerning prostate cancer screening and requires coverage be provided without cost sharing.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health insurance coverage for prostate cancer screening and amending P.L.1996, c.125 and supplementing various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.1996, c.125 (C.17:48E-35.13) is amended to read as follows:.
1. a. No health service corporation contract providing hospital or medical expense benefits [for groups with greater than 49 persons] shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of [this act] P.L.1996, c.125 (C.17:48E-35.13 et al.), unless the contract provides benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting an annual [medically recognized diagnostic examination including, but not limited to, a digital rectal examination and a prostate-specific antigen test for men age 50 and over who are asymptomatic and for men age 40 and over with a family history of prostate cancer or other prostate cancer risk factors] prostate cancer screening.
The benefits shall be provided to the same extent as for any other medical condition under the contract except that no deductible, coinsurance, copayment, or any other cost-sharing requirement on the benefits shall be imposed for men who are between 40 and 75 years of age.
This section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.
b. As used in this section:
Prostate cancer screening means medically viable methods for the detection and diagnosis of prostate cancer, which includes a digital rectal exam and the prostate-specific antigen test and associated laboratory work. Prostate cancer screening shall also include subsequent follow up testing as direct by a health care provider, including, but not limited to:
(1) urinary analysis;
(2) serum biomarkers;
(3) medical imaging, including, but not limited to, magnetic resonance imaging.
(cf: P.L.1996, c.125, s.1)
2. Section 2 of P.L.1996, c.125 (C.17:48-6p) is amended to read as follows:
2. a. No hospital service corporation contract providing hospital or medical expense benefits [for groups with greater than 49 persons] shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of [this act] P.L.1996, c.125 (C.17:48E-35.13 et al.), unless the contract provides benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting an annual [medically recognized diagnostic examination including, but not limited to, a digital rectal examination and a prostate-specific antigen test for men age 50 and over who are asymptomatic and for men age 40 and over with a family history of prostate cancer or other prostate cancer risk factors] prostate cancer screening.
The benefits shall be provided to the same extent as for any other medical condition under the contract except that no deductible, coinsurance, copayment, or any other cost-sharing requirement on the benefits shall be imposed for men who are between 40 and 75 years of age.
This section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
b. As used in this section:
Prostate cancer screening means medically viable methods for the detection and diagnosis of prostate cancer, which includes a digital rectal exam and the prostate-specific antigen test and associated laboratory work. Prostate cancer screening shall also include subsequent follow up testing as direct by a health care provider, including, but not limited to:
(1) urinary analysis;
(2) serum biomarkers;
(3) medical imaging, including, but not limited to, magnetic resonance imaging.
(cf: P.L.1996, c.125, s.2)
3. Section 3 of P.L.1996, c.125 (C.17:48A-7n) is amended to read as follows:
3. a. No medical service corporation contract providing hospital or medical expense benefits [for groups with greater than 49 persons] shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of [this act] P.L.1996, c.125 (C.17:48E-35.13 et al.), unless the contract provides benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting an annual [medically recognized diagnostic examination including, but not limited to, a digital rectal examination and a prostate-specific anitgen test for men age 50 and over who are asymptomatic and for men age 40 and over with a family history of prostate cancer or other prostate cancer risk factors] prostate cancer screening.
The benefits shall be provided to the same extent as for any other medical condition under the contract except that no deductible, coinsurance, copayment, or any other cost-sharing requirement on the benefits shall be imposed for men who are between 40 and 75 years of age.
This section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
b. As used in this section:
Prostate cancer screening means medically viable methods for the detection and diagnosis of prostate cancer, which includes a digital rectal exam and the prostate-specific antigen test and associated laboratory work. Prostate cancer screening shall also include subsequent follow up testing as direct by a health care provider, including, but not limited to:
(1) urinary analysis;
(2) serum biomarkers;
(3) medical imaging, including, but not limited to, magnetic resonance imaging.
(cf: P.L.1996, c.125, s.3)
4. Section 4 of P.L.1996, c.125 (C.17B:27-46.1o) is amended to read as follows:
4. a. No group health insurance policy providing hospital or medical expense benefits [for groups with greater than 49 persons] shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of [this act] P.L.1996, c.125 (C.17:48E-35.13 et al.), unless the policy provides benefits