Sec. 21.42.377. Coverage for colorectal cancer screening.
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Sec. 21.42.377. Coverage for colorectal cancer screening.
(a)Except for a fraternal benefit society, a health care insurer that offers, issues for delivery, delivers, or renews in this state a health care insurance plan shall provide coverage for the costs of colorectal cancer screening examinations and laboratory tests under the schedule described in
(b)of this section. The coverage required by this section is subject to standard policy provisions applicable to other benefits, including deductible or copayment provisions.
(b)The minimum coverage required under
(a)of this section for colorectal cancer screening includes coverage for colorectal cancer examinations and laboratory tests specified in American Cancer Society guidelines for colorectal cancer screening of asymptomatic individuals. Coverage shall be provided for all colorectal screening examinations and tests that are administered at a frequency identified in the American Cancer Society guidelines for colorectal cancer.
(c)Coverage provided under this section applies to a covered individual who is
(1)at least 50 years of age; or
(2)less than 50 years of age and at high risk for colorectal cancer.
(d)All screening options identified in
(b)of this section shall be covered by the insurer, with the choice of option determined by the covered individual in consultation with a health care provider.
(e)For individuals considered at average risk for colorectal cancer, coverage or benefits shall be provided for the choice of screening, so long as it is conducted in accordance with the specified frequency. For individuals considered at high risk for colorectal cancer, screening shall be provided at a frequency determined necessary by a health care provider.
(f)An employer that provides a health care insurance plan under this section shall notify each covered individual of the coverage for colorectal cancer screenings unless coverage for colorectal cancer screening previously exists. The notice shall be included in the health benefit handbook or be provided by written or electronic communication between an employer or health plan administrator and a covered individual. However, if the covered individual purchases the health care insurance plan from the insurer issuing the policy, the insurer is responsible for notifying the covered individual of the coverage for colorectal cancer screening under this section.
(g)In this section, “individual considered at high risk for colorectal cancer” means an individual who faces a high risk for colorectal cancer because of
(1)family history;
(2)prior experience of cancer or precursor neoplastic polyps;
(3)a history of a chronic digestive disease condition, including inflammatory bowel disease, Crohn's Disease, or ulcerative colitis;
(4)the presence of any appropriate recognized gene markers for colorectal cancer; or
(5)other predisposing factors.