Today's Law As Amended


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AB-1520 Health care coverage: prostate cancer: screening.(2021-2022)



As Amends the Law Today


SECTION 1.

 Section 1367.64 of the Health and Safety Code is amended to read:

1367.64.
 (a)  Every individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, or renewed on or after January 1, 1999, shall be deemed to provide coverage for the screening and diagnosis of prostate cancer, including, but not limited to, prostate-specific antigen testing and digital rectal examinations, when medically necessary and consistent with good professional practice.
(b) Nothing in this section shall be construed to  This section does not  establish a new mandated benefit or to  prevent application of deductible or copayment provisions in a policy or plan, nor shall does  this section be construed to  require that a policy or plan be extended to cover any other procedures under an individual or a group  a  health care service plan contract. Nothing in this section shall be construed to  This section does not  authorize an enrollee to receive the services required to be covered by this section if those services are furnished by a nonparticipating provider, unless the enrollee is referred to that provider by a participating physician or nurse practitioner providing care.
(c) (1) Notwithstanding subdivision (b), a health care service plan contract, except a specialized health care service plan contract, that is issued, amended, or renewed on or after January 1, 2022, shall not apply a deductible, copayment, or coinsurance to coverage for screening services for prostate cancer described in subdivision (a) for an enrollee who meets either of the criteria in paragraph (2).
(2) This subdivision applies to both of the following:
(A) A person with a prostate who is 55 years of age or older.
(B) (i) A person with a prostate who is 40 years of age or older and who is high risk, as determined by the attending or treating health care provider.
(ii) “High risk” includes, but is not limited to, a person with a prostate who is Black, has a family history of prostate cancer, has a genetic predisposition to prostate cancer, or is a veteran.
(3) For high deductible plans, this subdivision is subject to federal guidance on the preventive care safe harbor for the absence of a preventive care deductible provided for under 26 U.S.C. Sec. 223(c)(2)(C).

SEC. 2.

 Section 10123.835 of the Insurance Code is amended to read:

10123.835.
 (a) Every individual or group policy of disability insurance that covers hospital, medical, or surgical benefits that  A health insurance policy that  is issued, amended, or renewed on or after January 1, 1999, shall be deemed to provide coverage for the screening and diagnosis of prostate cancer, including, but not limited to, prostate-specific antigen testing and digital rectal examinations, when medically necessary and consistent with good professional practice.
(b) Nothing in this section shall be construed to require an individual or group  This section does not require a health insurance  policy to cover the surgical and other procedures known as radical prostatectomy, external beam radiation therapy, radiation seed implants, and combined hormonal therapy, or to prevent application of deductible or copayment provisions contained in the policy, nor shall does  this section be construed to  require that coverage under an individual or group policy  a health insurance policy to  be extended to any other procedures.
(c) (1) Notwithstanding subdivision (b), a health insurance policy that is issued, amended, or renewed on or after January 1, 2022, shall not apply a deductible, copayment, or coinsurance to coverage for screening services for prostate cancer described in subdivision (a) for an insured who meets either of the criteria in paragraph (2).
(2) This subdivision applies to both of the following:
(A) A person with a prostate who is 55 years of age or older.
(B) (i) A person with a prostate who is 40 years of age or older and who is high risk, as determined by the attending or treating health care provider.
(ii) “High risk” includes, but is not limited to, a person with a prostate who is Black, has a family history of prostate cancer, has a genetic predisposition to prostate cancer, or is a veteran.
(3) For high deductible plans, this subdivision is subject to federal guidance on the preventive care safe harbor for the absence of a preventive care deductible provided for under 26U.S.C. Sec. 223(c)(2)(C).
(c) (d)  This section shall does  not apply to specified accident, specified disease, hospital indemnity, Medicare supplement, or long-term care health insurance policies.
SEC. 3.
 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.