26:2J-4.24 HMO agreement to provide coverage for colorectal cancer screening.
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 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.
L.2001, c.295, s.8; amended 2012, c.17, s.273.
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Last modified: October 11, 2016