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§36-6060.8.
§36-6060.8.
A. Any health benefit plan that is offered, issued or renewed in this
state on or after January 1, 2000, which provides coverage to men
forty (40) years old or older in this state, shall offer coverage for
annual screening for the early detection of prostate cancer in men
over the age of fifty (50) years and in men over the age of forty (40)
years who are in high-risk categories. The coverage shall not be
subject to policy deductibles. The coverage shall not exceed:
The actual cost of the prostate cancer screening up to a maximum of
Sixty-five Dollars ($65.00) per screening.
B. The benefit required to be provided by subsection A of this section
shall in no way diminish or limit diagnostic benefits otherwise
allowable under a health benefit plan.
C. The prostate cancer screening coverage shall be offered as follows:
1. The screening shall be performed by a qualified medical
professional including, but not limited to, a urologist, internist,
general practitioner, doctor of osteopathy, nurse practitioner, or
physician assistant;
2. The screening shall consist, at a minimum, of the following tests:
a. a prostate-specific antigen blood test, and
b. a digital rectal examination;
3. At least one screening per year shall be covered for any man fifty
(50) years of age or older; and
4. At least one screening per year shall be covered for any man from
forty (40) to fifty (50) years of age who is at increased risk of
developing prostate cancer as determined by a physician.
D. As used in this section, "health benefit plan" means group hospital
or medical insurance coverage, a not-for-profit hospital or medical
service or indemnity plan, a prepaid health plan, a health maintenance
organization plan, a preferred provider organization plan, the State
and Education Employees Group Health Insurance Plan, any program
funded under Title XIX of the Social Security Act, or such other
publicly funded program, and coverage provided by a Multiple Employer
Welfare Arrangement (MEWA) or employee self-insured plan except as
exempt under federal ERISA provisions. The term shall not include
short-term, accident, fixed indemnity, or specified disease policies,
disability income contracts, limited benefit or credit disability
insurance, workers' compensation insurance coverage, automobile
medical payment insurance, or insurance under which benefits are
payable with or without regard to fault and which is required by law
to be contained in any liability insurance policy or equivalent
self-insurance.
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