- (a) As used in this section, "colorectal cancer testing" means examinations and laboratory tests for cancer for any nonsymptomatic enrollee.
- (b) As used in this section, "follow-up colonoscopy" means a colonoscopy that is performed as a follow-up to a colorectal cancer screening test, other than a colonoscopy, that is assigned a grade of "A" or "B" by the United States Preventive Services Task Force and for which the result was positive.
(c) Except as provided in subsection (f), a health maintenance organization issued a certificate of authority in Indiana shall provide colorectal cancer testing, including:
- (1) a colorectal cancer screening test assigned either an "A" or "B" grade by the United States Preventive Services Task Force; and
(2) a follow-up colonoscopy;
as a covered service under every group contract that provides coverage for basic health care services.
(d) For an enrollee who is:
- (1) at least forty-five (45) years of age; or
(2) less than forty-five (45) years of age and at high risk for colorectal cancer;
the colorectal cancer testing required under this section must meet the requirements set forth in subsection (e), except as provided in subsection (g).
- (e) An enrollee may not be required to pay a copayment for the colorectal cancer testing benefit required by this section that is greater than a copayment established for similar benefits under the group contract under which the enrollee is entitled to services. If the group contract does not cover a similar covered service, the copayment for the colorectal cancer testing benefit may not be set at a level that materially diminishes the value of the colorectal cancer testing benefit.
- (f) In the case of coverage that is not employer based, the health maintenance organization is required only to offer to provide colorectal cancer testing as a covered service under a proposed group contract providing coverage for basic health care services.
- (g) The requirements imposed under subsection (c)(2) do not apply to grandfathered health plans as defined in 45 CFR 147.140.
As added by P.L.54-2000, SEC.3. Amended by P.L.1-2001, SEC.34; P.L.124-2018, SEC.90; P.L.36-2020, SEC.3; P.L.165-2022, SEC.13.