OLR Bill Analysis

sSB 923 (File 221, as amended by Senate "A")*

AN ACT CONCERNING THE AMERICAN COLLEGE OF RADIOLOGY AND COLORECTAL CANCER SCREENING RECOMMENDATIONS.

SUMMARY:

By law, certain health insurance policies must cover colorectal cancer screening, including (1) an annual fecal occult blood test and (2) colonoscopy, flexible sigmoidoscopy, or radiologic imaging, in accordance with American College of Gastroenterology (ACOG) recommendations regarding age, family history, and test frequency. This bill requires ACOG to consult with the American College of Radiology, not just the American Cancer Society, when making screening recommendations.

The bill also prohibits these insurance policies from imposing a coinsurance, copayment, deductible, or other out-of-pocket expense for any additional colonoscopy a physician orders for an insured person in a policy year. Other than this prohibition, benefits are subject to the same terms and conditions that apply to policy benefits. The bill specifies that its prohibition does not apply to a high-deductible health plan designed to be compatible with federally qualified health savings accounts.

The individual and group health insurance policies covered by the bill are those delivered, issued, amended, renewed, or continued in Connecticut that cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses; and (4) hospital or medical services, including coverage under an HMO plan. Due to the federal Employee Retirement Income Security Act (ERISA), state insurance benefit mandates do not apply to self-insured plans.

*Senate Amendment “A” adds the provision prohibiting insurers from imposing out-of-pocket expenses for any additional colonoscopy a physician orders for an insured person in a policy year.

EFFECTIVE DATE: January 1, 2012

COMMITTEE ACTION

Insurance and Real Estate Committee

Joint Favorable Substitute

Yea

18

Nay

2

(03/15/2011)

Appropriations Committee

Joint Favorable

Yea

30

Nay

16

(05/16/2011)