CHAPTER 14.7. COVERAGE FOR SERVICES RELATED TO PROSTATE CANCER SCREENING
IC 27-8-14.7
Chapter 14.7. Coverage for Services Related to Prostate Cancer
Screening
IC 27-8-14.7-1
"Accident and sickness insurance policy" defined
Sec. 1. (a) As used in this chapter, "accident and sickness
insurance policy" means an insurance policy that:
(1) provides at least one (1) of the types of insurance described
in IC 27-1-5-1, Classes 1(b) and 2(a); and
(2) is issued on a group basis.
(b) "Accident and sickness insurance policy" does not include the
following:
(1) Accident only, credit, dental, vision, Medicare supplement,
long term care, or disability income insurance.
(2) Coverage issued as a supplement to liability insurance.
(3) Worker's compensation or similar insurance.
(4) Automobile medical payment insurance.
(5) A specified disease policy.
(6) A short term insurance plan that:
(A) may not be renewed; and
(B) has a duration of not more than six (6) months.
(7) A policy that provides indemnity benefits not based on any
expense incurred requirement, including a plan that provides
coverage for:
(A) hospital confinement, critical illness, or intensive care;
or
(B) gaps for deductibles or copayments.
(8) A supplemental plan that always pays in addition to other
coverage.
(9) A student health plan.
(10) An employer sponsored health benefit plan that is:
(A) provided to individuals who are eligible for Medicare;
and
(B) not marketed as, or held out to be, a Medicare
supplement policy.
As added by P.L.170-1999, SEC.4. Amended by P.L.173-2007,
SEC.34.
IC 27-8-14.7-2
"Insured" defined
Sec. 2. As used in this chapter, "insured" means a male individual
who is entitled to coverage under a policy of accident and sickness
insurance.
As added by P.L.170-1999, SEC.4.
IC 27-8-14.7-3
"Prostate specific antigen test" defined
Sec. 3. As used in this chapter, "prostate specific antigen test"
means a standard blood test performed to determine the level of
prostate specific antigen in the blood.
As added by P.L.170-1999, SEC.4.
IC 27-8-14.7-4
Coverage required
Sec. 4. (a) Except as provided in subsection (f), an insurer shall
provide coverage for prostate specific antigen testing in any accident
and sickness insurance policy that the insurer issues in Indiana.
(b) Except as provided in subsection (f), the coverage required
under subsection (a) must include the following:
(1) At least one (1) prostate specific antigen test annually for an
insured who is at least fifty (50) years of age.
(2) At least one (1) prostate specific antigen test annually for an
insured who is less than fifty (50) years of age and who is at
high risk for prostate cancer according to the most recent
published guidelines of the American Cancer Society.
(c) An insured may not be required to pay an annual deductible or
coinsurance that is greater than an annual deductible or coinsurance
established for similar benefits under the accident and sickness
insurance policy. If the policy does not cover a similar benefit, the
deductible or coinsurance may not be set at a level that materially
diminishes the value of the prostate specific antigen testing benefit
required by this chapter.
(d) Except as provided in subsection (f), the coverage that an
insurer must provide under this chapter may not be subject to dollar
limits, deductibles, or coinsurance provisions that are less favorable
to the insured than the dollar limits, deductibles, or coinsurance
provisions applying to physical illness generally under the accident
and sickness insurance policy.
(e) Except as provided in subsection (f), the coverage that an
insurer must provide is in addition to any benefits specifically
provided for x-rays, laboratory testing, or wellness examinations.
(f) In the case of insurance policies that are not employer based,
the insurer must offer to provide the coverage described in
subsections (a) through (e).
As added by P.L.170-1999, SEC.4.