As used in this subchapter: (1) “Covered person” means a person who is and continues to remain eligible for coverage under a healthcare policy and is covered under a healthcare policy; (2) (A) “Healthcare policy” means: (i) An individual or group health insurance policy providing coverage on an expense-incurred basis; (ii) An individual or group […]
(a) A healthcare policy subject to this subchapter executed, delivered, issued for delivery, continued, or renewed in this state on or after August 1, 2005, shall include colorectal cancer examinations and laboratory tests within the healthcare policy’s coverage. (b) The coverage shall include colorectal cancer examinations and laboratory tests for: (1) Covered persons who are […]
(a) This subchapter does not prohibit the issuance of policies that provide benefits greater than those required by § 23-79-1202 or more favorable to the insured than those required by § 23-79-1202. (b) This subchapter does not prohibit the payment of different levels of benefits or from having differences in coinsurance percentages applicable to benefit […]
(a) Except as provided in subsection (b) of this section, the coverage offered under § 23-79-1202 may contain any exclusions, reductions, or other limitations approved by the Insurance Commissioner concerning coverages, deductibles, or coinsurance provisions. (b) The benefits provided in this subchapter shall be subject to the same annual deductible or coinsurance established for all […]
(a) (1) This subchapter does not require and shall not be construed to require the coverage of services by providers who are not designated as covered providers or that are not selected as a participating provider by a group health benefit plan or insurer having a participating network of service providers. (2) This subchapter does […]
The issuer of a healthcare policy shall conform its policies, contracts, or certificates issued on or after August 1, 2005, and may adjust its premium cost to reflect the additional benefit cost.
(a) To encourage colorectal cancer screenings, patients and healthcare providers may not be required to meet burdensome criteria or overcome significant obstacles to obtain coverage. (b) An individual shall not be required to pay an additional deductible or coinsurance for testing that is greater than an annual deductible or coinsurance established for similar benefits. (c) […]
A healthcare policy is not required to provide a referral under this subchapter to a nonparticipating healthcare provider unless the plan or carrier does not have a participating healthcare provider that is available and accessible to administer the screening, examination, or treatment of colorectal cancer.
If a healthcare policy refers an individual under this subchapter to a nonparticipating healthcare provider, then services provided under the approved screening exam or resulting treatment, if any, shall be provided at no additional cost to the individual beyond what the individual would otherwise pay to a participating healthcare provider.
