H 4538 General Bill, By J.S. Shissias, Allison, T. Brown, A.W. Byrd, B.D. Cain, 
Cobb-Hunter, J.L.M. Cromer, Gamble, J.L. Harris, Harrison, Howard, Keegan, 
W.D. Keyserling, Lee, J.G. McAbee, D.E. McTeer, Moody-Lawrence, Neilson, Riser, 
Seithel, Spearman, Stille, Stuart, P.H. Thomas, J.W. Tucker, C.C. Wells, 
L.S. Whipper, J.M. White, D. Williams, Witherspoon and Young-Brickell
 A Bill to amend the Code of Laws of South Carolina, 1976, by adding Section
 38-33-85 and Section 38-71-144 so as to require health maintenance
 organization contracts, group accident and health insurance policies, and
 group health insurance policies to include coverage for mammography screening,
 pap smears, and testing for prostate cancer.

   02/01/96  House  Introduced and read first time HJ-11
   02/01/96  House  Referred to Committee on Labor, Commerce and
                     Industry HJ-11

A BILL

TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-33-85 AND SECTION 38-71-144 SO AS TO REQUIRE HEALTH MAINTENANCE ORGANIZATION CONTRACTS, GROUP ACCIDENT AND HEALTH INSURANCE POLICIES, AND GROUP HEALTH INSURANCE POLICIES TO INCLUDE COVERAGE FOR MAMMOGRAPHY SCREENING, PAP SMEARS, AND TESTING FOR PROSTATE CANCER.

Be it enacted by the General Assembly of the State of South Carolina:

SECTION 1. The 1976 Code is amended by adding:

"Section 38-33-85. A health maintenance organization contract must include coverage for medically appropriate low dose screening mammography, pap smears, and prostate specific antigen or equivalent tests for the presence of prostate cancer. `Medically appropriate' means that the procedure is:

(1) ordered by the patient's physician; and

(2) certified by the health maintenance organization's utilization review program, if any, as meeting the health maintenance organization's written utilization criteria for these screening procedures.

Coverage must include the examination, laboratory fee, and the physician's interpretation of the results. The coverage may contain the same limitations, exclusions, utilization review requirements, deductibles, or coinsurance provisions which apply generally to similar benefits provided or paid under the contract. The coverage also may contain other limitations, exclusions, utilization review requirements, deductibles, or coinsurance provisions as may be approved by the director."

SECTION 2. The 1976 Code is amended by adding:

"Section 38-71-144. A group accident and health insurance policy and a group health insurance policy must include coverage for medically appropriate low dose screening mammography, pap smears, and prostate specific antigen or equivalent tests for the presence of prostate cancer. `Medically appropriate' means that the procedure is:

(1) ordered by the patient's physician; and

(2) certified by the insurer's utilization review program, if any, as meeting the insurer's written utilization criteria for these screening procedures.

Coverage must include the examination, laboratory fee, and the physician's interpretation of the results. The coverage may contain the same limitations, exclusions, utilization review requirements, deductibles, or coinsurance provisions which apply generally to similar benefits provided or paid under the policy. The coverage also may contain other limitations, exclusions, utilization review requirements, deductibles, or coinsurance provisions as may be approved by the director."

SECTION 3. This act takes effect upon approval by the Governor and applies to all group accident and health insurance policies, group health insurance policies, and group health maintenance organization contracts issued or renewed after July 1, 1997.