CHAPTER 295

 

An Act requiring health insurance benefits for expenses incurred for colorectal cancer screening and supplementing P.L.1938, c.366 (C.17:48-1 et seq.), P.L.1940, c.74 (C.17:48A-1 et seq.), P.L.1985, c.236 (C.17:48E-1 et seq.), chapters 26 and 27 of Title 17B of the New Jersey Statutes, P.L.1992, c.161 (C.17B:27A-2 et seq.), P.L.1992, c.162 (C.17B:27A-17 et seq.), and P.L.1973, c.337 (C.26:2J-1 et seq.).


    Be It Enacted by the Senate and General Assembly of the State of New Jersey:


C.17:48-6y Hospital service corporation to provide coverage for colorectal cancer screening.

    1.    Every hospital service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age 50 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.

    As used in this section, "high risk for colorectal cancer" means a person has:

    a.    a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;

     b.    chronic inflammatory bowel disease; or

     c.    a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.

    The benefits shall be provided to the same extent as for any other medical condition under the contract.

    The provisions of this section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.


C.17:48A-7x Medical service corporation to provide coverage for colorectal cancer screening.

    2.    Every medical service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age 50 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.

    As used in this section, "high risk for colorectal cancer" means a person has:

    a.    a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;

     b.    chronic inflammatory bowel disease; or

     c.    a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.

    The benefits shall be provided to the same extent as for any other medical condition under the contract.

    The provisions of this section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.


C.17:48E-35.23 Health service corporation to provide coverage for colorectal cancer screening.

    3.    Every health service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age 50 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.

    As used in this section, "high risk for colorectal cancer" means a person has:

    a.    a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;

     b.    chronic inflammatory bowel disease; or

     c.    a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.

    The benefits shall be provided to the same extent as for any other medical condition under the contract.

    The provisions of this section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.


C.17B:26-2.1u Individual policy to provide coverage for colorectal cancer screening.

    4.    Every individual policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:26-1 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named insured or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age 50 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.

    As used in this section, "high risk for colorectal cancer" means a person has:

    a.    a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;

     b.    chronic inflammatory bowel disease; or

     c.    a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.

    The benefits shall be provided to the same extent as for any other medical condition under the policy.

    The provisions of this section shall apply to all health insurance policies in which the insurer has reserved the right to change the premium.


C.17B:27-46.1y Group policy to provide coverage for colorectal cancer screening.

    5.    Every group policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:27-26 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named insured or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age 50 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.

    As used in this section, "high risk for colorectal cancer" means a person has:

    a.    a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;

     b.    chronic inflammatory bowel disease; or

     c.    a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.

    The benefits shall be provided to the same extent as for any other medical condition under the policy.

    The provisions of this section shall apply to all health insurance policies in which the insurer has reserved the right to change the premium.


C.17B:27A-7.7 Individual health benefits plan to provide coverage for colorectal cancer screening.

     6.    Every individual health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), or approved for issuance or renewal in this State on or after the effective date of this act, shall provide benefits to any person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age 50 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.

    As used in this section, "high risk for colorectal cancer" means a person has:

    a.    a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;

     b.    chronic inflammatory bowel disease; or

     c.    a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.

    The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.

    The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.


C.17B:27A-19.9 Small employer health benefits plan to provide coverage for colorectal cancer screening.

    7.    Every small employer health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), or approved for issuance or renewal in this State on or after the effective date of this act, shall provide benefits to any person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age 50 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.

    As used in this section, "high risk for colorectal cancer" means a person has:

    a.    a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;

     b.    chronic inflammatory bowel disease; or

     c.    a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.

    The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.

    The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.


C.26:2J-4.24 HMO agreement to provide coverage for colorectal cancer screening.

    8.    Every enrollee agreement that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Health and Senior Services on or after the effective date of this act, shall provide health care services to any enrollee or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age 50 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.

    As used in this section, "high risk for colorectal cancer" means a person has:

    a.    a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;

     b.    chronic inflammatory bowel disease; or

     c.    a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.

    The health care services shall be provided to the same extent as for any other medical condition under the enrollee agreement.

    The provisions of this section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges.


    9.    This act shall take effect on the 180th day after enactment.


    Approved December 31, 2001.