Bill Text: NJ A5034 | 2020-2021 | Regular Session | Amended
Bill Title: Reduces age at which health benefit plans cover colorectal cancer screenings from 50 to 45.
Spectrum: Moderate Partisan Bill (Democrat 15-2)
Status: (Introduced - Dead) 2021-06-02 - Reported out of Asm. Comm. with Amendments, and Referred to Assembly Appropriations Committee [A5034 Detail]
Download: New_Jersey-2020-A5034-Amended.html
ASSEMBLY, No. 5034
STATE OF NEW JERSEY
219th LEGISLATURE
INTRODUCED NOVEMBER 19, 2020
Sponsored by:
Assemblyman DANIEL R. BENSON
District 14 (Mercer and Middlesex)
Assemblywoman CAROL A. MURPHY
District 7 (Burlington)
Assemblyman HERB CONAWAY, JR.
District 7 (Burlington)
Co-Sponsored by:
Assemblymen Verrelli, Holley, Chiaravalloti, Dancer, Assemblywomen Reynolds-Jackson, Chaparro, Jasey, Assemblyman Wimberly, Assemblywomen Vainieri Huttle, Quijano, Assemblymen DePhillips, Johnson, Giblin and Assemblywoman Speight
SYNOPSIS
Reduces age at which health benefit plans cover colorectal cancer screenings from 50 to 45.
CURRENT VERSION OF TEXT
As reported by the Assembly Health Committee on June 2, 2021, with amendments.
An Act concerning health benefits for colorectal cancer screenings, amending P.L.2001, c.295, and supplementing P.L.1961, c.49.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.2001, c.295 (C.17:48-6y) is amended to read as follows:
1. Every hospital service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age [50] 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.
As used in this section, "high risk for colorectal cancer" means a person has:
a. a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;
b. chronic inflammatory bowel disease; or
c. a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
The benefits shall be provided to the same extent as for any other medical condition under the contract.
The provisions of this section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
(cf: P.L.2001, c.295, s.1)
2. Section 2 of P.L.2001, c.295 (C.17:48A-7x) is amended to read as follows:
2. Every medical service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age [50] 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.
As used in this section, "high risk for colorectal cancer" means a person has:
a. a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;
b. chronic inflammatory bowel disease; or
c. a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
The benefits shall be provided to the same extent as for any other medical condition under the contract.
The provisions of this section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
(cf: P.L.2001, c.295, s.2)
3. Section 3 of P.L.2001, c.295 (C.17:48E-35.23) is amended to read as follows:
3. Every health service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age [50] 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.
As used in this section, "high risk for colorectal cancer" means a person has:
a. a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;
b. chronic inflammatory bowel disease; or
c. a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
The benefits shall be provided to the same extent as for any other medical condition under the contract.
The provisions of this section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.
(cf: P.L.2001, c.295, s.3)
4. Section 4 of P.L.2001, c.295 (C.17B:26-2.1u) is amended to read as follows:
4. Every individual policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:23-1 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named insured or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age [50] 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.
As used in this section, "high risk for colorectal cancer" means a person has:
a. a family history of: familial adenomatous polyposis; hereditary nonpolyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;
b. chronic inflammatory bowel disease; or
c. a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
The benefits shall be provided to the same extent as for any other medical condition under the policy.
The provisions of this section shall apply to all health insurance policies in which the insurer has reserved the right to change the premium.
(cf: P.L.2001, c.295, s.4)
5. Section 5 of P.L.2001, c.295 (C.17B:27-46.1y) is amended to read as follows:
5. Every group policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:27-26 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named insured or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age [50] 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.
As used in this section, "high risk for colorectal cancer" means a person has:
a. a family history of: familial adenomatous polyposis; hereditary nonpolyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;
b. chronic inflammatory bowel disease; or
c. a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
The benefits shall be provided to the same extent as for any other medical condition under the policy.
The provisions of this section shall apply to all health insurance policies in which the insurer has reserved the right to change the premium.
(cf: P.L.2001, c.295, s.5)
6. Section 8 of P.L.2001, c.295 (C.26:2J-4.24) is amended to read as follows:
8. Every enrollee agreement that provides hospital or medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide health care services to any enrollee or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age [50] 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.
As used in this section, "high risk for colorectal cancer" means a person has:
a. a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;
b. chronic inflammatory bowel disease; or
c. a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
The health care services shall be provided to the same extent as for any other medical condition under the enrollee agreement.
The provisions of this section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges.
(cf: P.L.2012, c.17, s.273)
7. Section 6 of P.L.2001, c.295 (C.17B:27A-7.7) is amended to read as follows:
6. Every individual health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), or approved for issuance or renewal in this State on or after the effective date of this act, shall provide benefits to any person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age [50] 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.
As used in this section, "high risk for colorectal cancer" means a person has:
a. a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;
b. chronic inflammatory bowel disease; or
c. a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.
(cf: P.L.2001, c.295, s.6)
8. Section 7 of P.L.2001, c.295 (C.17B:27A-19.9) is amended to read as follows:
7. Every small employer health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), or approved for issuance or renewal in this State on or after the effective date of this act, shall provide benefits to any person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age [50] 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.
As used in this section, "high risk for colorectal cancer" means a person has:
a. a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;
b. chronic inflammatory bowel disease; or
c. a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.
(cf: P.L.2001, c.295, s.7)
9. (New Section) 1[Every State Health Benefits plan] The State Health Benefits Commission shall ensure that every contract, purchased by the commission on or after the effective date of this act,1 that provides hospital or medical expense benefits 1[and is delivered, issued, executed or renewed in this State pursuant to P.L.1961, c.49 (C.52:14-17.25 et seq.), or approved for issuance or renewal in this State on or after the effective date of this act,]1 shall provide benefits to any person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.
As used in this section, "high risk for colorectal cancer" means a person has:
a. a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;
b. chronic inflammatory bowel disease; or
c. a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
The benefits shall be provided to the same extent as for any other medical condition under the State Health Benefits plan.
110. (New Section) The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide benefits to any person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person.
As used in this section, "high risk for colorectal cancer" means a person has:
a. a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;
b. chronic inflammatory bowel disease; or
c. a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
The benefits shall be provided to the same extent as for any other medical condition under the State Health Benefits plan.1
1[10] 111. This act shall take effect 1[immediately] on the first day of the fourth month next following enactment and shall only apply to policies and contracts that are delivered, issued, executed, or renewed or approved for issuance or renewal in the State on or after the effective date1.
