ASSEMBLY, No. 1964

 

STATE OF NEW JERSEY

 

INTRODUCED MAY 6, 1996

 

 

By Assemblymen DeCROCE, BUCCO, Bodine and Augustine

 

 

An Act requiring health insurance benefits for testing for prostate cancer and supplementing Titles 17 and 26 of the Revised Statutes and Title 17B of the New Jersey Statutes.

 

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

 

    1. 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, 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, transrectal ultrasonagraphy 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.

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

    This section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.

 

    2. 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, 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, transrectal ultrasonagraphy 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.

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

    This section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.

 

    3. 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, 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, transrectal ultrasonagraphy 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.

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

    This section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.

 

    4. 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, unless the policy provides benefits to any named insured 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, transrectal ultrasonagraphy 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.

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

    This section shall apply to all group health insurance policies in which the health insurer has reserved the right to change the premium.

 

    5. A certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued by the Commissioner of Health on or after the effective date of this act unless the health maintenance organization offers health care services to any enrollee which include an annual medically recognized diagnostic examination including, but not limited to, a digital rectal examination, transrectal ultrasonagraphy 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.

    The health care services 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 contracts for health care services by health maintenance organizations under which the right to change the schedule of charges for enrollee coverage is reserved.

 

    6. This act shall take effect on the 30th day after enactment.

 

 

STATEMENT

 

    This bill requires all health insurers which cover groups with 50 or more persons and health maintenance organizations to provide benefits for an annual medically recognized diagnostic examination including, but not limited to, a digital rectal examination, transrectal ultrasonagraphy and a prostate-specific anitgen (PSA) 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. The PSA blood test was recently approved by the federal Food and Drug Administration to help detect prostate cancer in men when used in conjuction with a digital rectal examination.

    Prostate cancer is the second leading cause of cancer death in men, and the American Cancer Society estimates that the disease will kill 41,400 men in 1996. An estimated 317,100 new cases in the United States will be detected in 1996. Between 1980 and 1990, prostate cancer incidence rates increased 50%, largely due to improved detection. It is expected that there will be further increases in the incidence of this disease with widespread use of PSA blood tests and accompanying diagnostic examinations.

 

 

 

Requires insurers to provide coverage for prostate cancer tests.