File No. 119

Senate, March 19, 2009

The Committee on Insurance and Real Estate reported through SEN. CRISCO of the 17th Dist., Chairperson of the Committee on the part of the Senate, that the substitute bill ought to pass.

AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR COLONOSCOPIES.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 38a-492k of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2010):

(a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state [on or after October 1, 2001,] shall provide coverage for colorectal cancer screening, including, but not limited to, (1) an annual fecal occult blood test, and (2) colonoscopy, flexible sigmoidoscopy or radiologic imaging, in accordance with the recommendations established by the American College of Gastroenterology, after consultation with the American Cancer Society, based on the ages, family histories and frequencies provided in the recommendations. [Benefits] Except as specified in subsection (b) of this section, benefits under this section shall be subject to the same terms and conditions applicable to all other benefits under such policies.

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for any additional colonoscopy ordered in a policy year by a physician for an insured. The provisions of this subsection shall not apply to a high deductible plan as that term is used in subsection (f) of section 38a-520.

Sec. 2. Section 38a-518k of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2010):

(a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state [on or after October 1, 2001,] shall provide coverage for colorectal cancer screening, including, but not limited to, (1) an annual fecal occult blood test, and (2) colonoscopy, flexible sigmoidoscopy or radiologic imaging, in accordance with the recommendations established by the American College of Gastroenterology, after consultation with the American Cancer Society, based on the ages, family histories and frequencies provided in the recommendations. [Benefits] Except as specified in subsection (b) of this section, benefits under this section shall be subject to the same terms and conditions applicable to all other benefits under such policies.

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for any additional colonoscopy ordered in a policy year by a physician for an insured. The provisions of this subsection shall not apply to a high deductible plan as that term is used in subsection (f) of section 38a-520.

Statement of Legislative Commissioners:

The title was changed to reflect the content of the bill.

The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose. In general, fiscal impacts are based upon a variety of informational sources, including the analyst's professional knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note

State Impact: None in FY 10 & FY 11; See Below for Out Year Impact

Municipal Impact:

Explanation

This mandate is not anticipated to impact the state employee and retiree health plan until after the policy is renewed on July 1, 2011. The state health plan currently provides coverage for in-network colorectal cancer screening, with no copayments for surgery or testing and no limit as to the number of colorectal cancer screening tests, provided they are medically necessary. The state POS plans currently require a 20% copayment for out-of-network colorectal cancer screening, whereas state POE plans do not cover these benefits out-of-network.

The mandate prohibits coinsurance, copayment, deductible or other out-of-pocket expense for any additional medically necessary colorectal cancer screening ordered in a given year. This would prevent the POS plan from charging the 20% copayment for any out-of-network follow-up tests. As a result, the annual cost to the state plan starting in FY 12 would be approximately $176,500. The bill prohibits imposing a copayment for colorectal cancer screening; however it does not require out-of-network coverage of these services. Therefore the mandate would not require the POE plans to begin offering this benefit out-of-network.

The mandate's provisions may increase costs to certain fully insured municipal plans which include copayments for colorectal cancer screening. The coverage requirements may result in increased premium costs when municipalities enter into new health insurance contracts after January 1, 2010. Due to federal law, municipalities with self-insured health plans are exempt from state health insurance benefit mandates.

The Out Years

It is estimated that the state employee and retiree health plan will incur an annual cost of $176,500 beginning in FY 12 as a result of eliminating POS plan copayments for currently covered out-of-network colorectal cancer screening. As previously stated, the bill's coverage requirements may also result in increased premium costs when municipalities enter into new health insurance contracts after January 1, 2010. The annualized ongoing fiscal impact identified above would continue into the future subject to inflation.

Sources: Office of the State Comptroller, Department of Insurance, Office of Legislative Research, Municipal Employees Health Insurance Plan (MEHIP) Schedule of Benefits, State Employee Health Plan Subscriber Agreement.

OLR Bill Analysis

sSB 638

AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR COLONOSCOPIES.

SUMMARY:

This bill prohibits certain health insurance policies from imposing a coinsurance, copayment, deductible, or other out-of-pocket expense for a second or subsequent colonoscopy a physician orders for an insured person in a policy year. It specifies that this prohibition does not apply to a high-deductible health plan designed to be compatible with federally qualified health savings accounts.

By law, a policy must cover colorectal cancer screening, including (1) an annual fecal occult blood test and (2) colonoscopy, flexible sigmoidoscopy, or radiologic imaging, in accordance with recommendations the American College of Gastroenterology, in consultation with the American Cancer Society, establishes based on age, family history, and frequency. Benefits are subject to the same terms and conditions that apply to others under the policy.

EFFECTIVE DATE: January 1, 2010

APPLICABILITY

The bill applies to individual and group health insurance policies delivered, issued, renewed, amended, or continued in Connecticut that cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses; and (4) hospital or medical services, including coverage under an HMO plan.

Due to federal law (ERISA), state insurance benefit mandates do not apply to self-insured benefit plans.

COMMITTEE ACTION

Insurance and Real Estate Committee

Joint Favorable