A bill

 

TO AMEND THE SOUTH CAROLINA CODE OF LAWS BY AMENDING SECTION 38-71-145, RELATING TO REQUIRED COVERAGE FOR MAMMOGRAMS, PAP SMEARS, AND PROSTATE CANCER EXAMINATIONS AND LIMITATIONS, SO AS TO DEFINE TERMS, REQUIRE HEALTH INSURANCE POLICIES IN THIS STATE TO ELIMINATE COST-SHARING REQUIREMENTS FOR PROSTATE CANCER EXAMINATIONS, SCREENINGS, AND DIAGNOSTIC LABORATORY, AND TO PROVIDE EXCEPTIONS CONCERNING THE APPLICATION OF CERTAIN FEDERAL LAW.

 

Be it enacted by the General Assembly of the State of South Carolina:

 

SECTION 1.  Section 38-71-145 of the S.C. Code is amended to read:

 

    Section 38-71-145. (A) For purposes of this section:

       (1) "Cost-sharing requirements" means a deductible, coinsurance, copayment, and any maximum limitation on the application of such a deductible, coinsurance, copayment, or similar out-of-pocket expense.

       (2) "Health insurance policy" means a health benefit plan, contract, or evidence of coverage providing health insurance coverage as defined in Section 38-71-670(6) and Section 38-71-840(14).

       (3) "Mammogram" means a radiological examination of the breast for purposes of detecting breast cancer when performed as a result of a physician referral or by a health testing service which utilizes radiological equipment approved by the Department of Public Health, which examination may be made with the following minimum frequency:

           (a) once as a base-line mammogram for a female who is at least thirty-five years of age but less than forty years of age;

           (b) once every two years for a female who is at least forty years of age but less than fifty years of age;

           (c) once a year for a female who is at least fifty years of age; or

           (d) in accordance with the most recent published guidelines of the American Cancer Society.

       (4) "Pap smear" means an examination of the tissues of the cervix of the uterus for the purpose of detecting cancer when performed upon the recommendation of a medical doctor, which examination may be made once a year or more often if recommended by a medical doctor.

    (A)(B) All individual and group health insurance and health maintenance organization policies in this State shall include coverage in the policy for:

       (1) mammograms;

       (2) annual pap smears;

       (3) prostate cancer examinations, screenings, and laboratory work for diagnostic purposes in accordance with the most recent published guidelines of the American Cancer Society National Comprehensive Cancer Network.

    (B)(C) The coverage required to be offered under subsectionsubsections (A)(B)(1) and (B)(2) may not contain any exclusions, reductions, or other limitations as to coverages, deductibles, or coinsurance provisions which apply to that coverage unless these provisions apply generally to other similar benefits provided and paid for under the health insurance policy.

    (D) A health insurance policy in this State may not impose any cost-sharing requirements on prostate cancer examinations, screenings, and laboratory work for diagnostic purposes furnished to an individual enrolled in the plan under subsection (B)(3). If under federal law the application of subsection (C) would result in a Health Savings Account ineligibility under Section 223 of the Internal Revenue Code, then this requirement only applies for Health Savings Account-qualified high deductible health plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under Section 223, except with respect to items or services that are preventative care pursuant to Section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of subsection (C) apply regardless of whether or not the minimum deductible under Section 223 has been satisfied.

    (C)(E) Nothing in this section prohibits a health insurance policy from providing benefits greater than those required to be offered by subsections (A)(B), and (B)(C), and (D) or more favorable to the enrollee than those required to be offered by subsections (A)(B), and (B)(C), and (D).

    (D)(F) This section applies to individual and group health insurance policies issued by a fraternal benefit society, an insurer, a health maintenance organization, or any similar entity, except as exempted by ERISA.

    (E) For purposes of this section:

       (1) "Mammogram" means a radiological examination of the breast for purposes of detecting breast cancer when performed as a result of a physician referral or by a health testing service which utilizes radiological equipment approved by the Department of Health and Environmental Control, which examination may be made with the following minimum frequency:

           (a) once as a base-line mammogram for a female who is at least thirty-five years of age but less than forty years of age;

           (b) once every two years for a female who is at least forty years of age but less than fifty years of age;

           (c) once a year for a female who is at least fifty years of age;  or

           (d) in accordance with the most recent published guidelines of the American Cancer Society.

       (2) "Pap smear" means an examination of the tissues of the cervix of the uterus for the purpose of detecting cancer when performed upon the recommendation of a medical doctor, which examination may be made once a year or more often if recommended by a medical doctor.

       (3) "Health insurance policy" means a health benefit plan, contract, or evidence of coverage providing health insurance coverage as defined in Section 38-71-670(6) and Section 38-71-840(14).

 

SECTION 2.  This act takes effect upon approval by the Governor.

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