No. 25. An act relating to cost-sharing for preventive services. (H.136) It is hereby enacted by the General Assembly of the State of Vermont:
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- Morgan Manning
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1 No. 25. An act relating to cost-sharing for preventive services. (H.136) It is hereby enacted by the General Assembly of the State of Vermont: Sec V.S.A. 4100a is amended to read: 4100a. MAMMOGRAMS; COVERAGE REQUIRED (a) Insurers shall provide coverage for screening by low-dose mammography for the presence of occult breast cancer, as provided by this subchapter. Benefits provided shall cover the full cost of the mammography service, subject to a co-payment no greater than the co-payment applicable to care or services provided by a primary care physician under the insured s policy, provided that no co-payment shall exceed $ Mammography services shall not be subject to deductible or coinsurance requirements. (b) For females 40 years or older, coverage shall be provided for an annual screening. For females less than 40 years of age, coverage for screening shall be provided upon recommendation of a health care provider. (c) After January 1, 1994, this section shall apply only to screening procedures conducted by test facilities accredited by the American College of Radiologists. (d) For purposes of this subchapter: (1) Insurer means any insurance company which provides health insurance as defined in subdivision 3301(a)(2) of this title, nonprofit hospital and medical service corporations, and health maintenance organizations. The term does not apply to coverage for specified disease or other limited benefit coverage.
2 No. 25 Page 2 of 6 (2) Low-dose mammography Mammography means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, screens, films and cassettes. The average radiation dose to the breast shall be the lowest dose generally recognized by competent medical authority to be practicable for yielding acceptable radiographic images. (3) Screening includes the low-dose mammography test procedure and a qualified physician s interpretation of the results of the procedure, including additional views and interpretation as needed. Sec V.S.A. 4100g is amended to read: 4100g. COLORECTAL CANCER SCREENING, COVERAGE REQUIRED (a) For purposes of this section: (1) Colonoscopy means a procedure that enables a physician to examine visually the inside of a patient s entire colon and includes the concurrent removal of polyps, biopsy, or both. (2) Insurer means insurance companies that provide health insurance as defined in subdivision 3301(a)(2) of this title, nonprofit hospital and medical services corporations, and health maintenance organizations. The term does not apply to coverage for specified disease or other limited benefit coverage.
3 No. 25 Page 3 of 6 (b) Insurers shall provide coverage for colorectal cancer screening, including: (1) Providing an insured 50 years of age or older with the option of: (A) Annual fecal occult blood testing plus one flexible sigmoidoscopy every five years; or (B) One colonoscopy every 10 years. (2) For an insured who is at high risk for colorectal cancer, colorectal cancer screening examinations and laboratory tests as recommended by the treating physician. (c) For the purposes of subdivision (b)(2) of this section, an individual is at high risk for colorectal cancer if the individual has: (1) A family medical history of colorectal cancer or a genetic syndrome predisposing the individual to colorectal cancer; (2) A prior occurrence of colorectal cancer or precursor polyps; (3) A prior occurrence of a chronic digestive disease condition such as inflammatory bowel disease, Crohn s disease, or ulcerative colitis; or (4) Other predisposing factors as determined by the individual s treating physician. (d) Benefits provided shall cover the colorectal cancer screening subject to a co-payment no greater than the co-payment applicable to care or services provided by a primary care physician under the insured s policy, provided that no co-payment shall exceed $ for services performed under contract
4 No. 25 Page 4 of 6 with the insurer. Colorectal cancer screening services performed under contract with the insurer also shall not be subject to deductible or coinsurance requirements. In addition, an insured shall not be subject to any additional charge for any service associated with a procedure or test for colorectal cancer screening, which may include one or more of the following: (1) removal of tissue or other matter; (2) laboratory services; (3) physician services; (4) facility use; and (5) anesthesia. (e) If determined to be permitted by Centers for Medicare and Medicaid Services, for a patient covered under the Medicare program, the patient s out-of-pocket expenditure for a colorectal cancer screening shall not exceed $100.00, with the hospital or other health care facility where the screening is performed absorbing the difference between the Medicare payment and the Medicare negotiated rate for the screening. [Deleted.] Sec. 3. STATUTORY CONSTRUCTION; LEGISLATIVE INTENT The express enumeration of the services associated with a procedure or test for colorectal cancer in 8 V.S.A. 4100g(d) shall not be construed as indicating legislative intent with respect to the scope of covered services associated with any other procedure or test referenced in the Vermont Statutes Annotated.
5 No. 25 Page 5 of 6 Sec V.S.A. 4100a(a) is amended to read: (a) Insurers shall provide coverage for screening by mammography for the presence of occult breast cancer, as provided by this subchapter. Benefits provided shall cover the full cost of the mammography service, subject to a copayment no greater than the co-payment applicable to care or services provided by a primary care physician under the insured s policy, provided that no copayment shall exceed $ Mammography services and shall not be subject to any co-payment, deductible, or coinsurance requirements, or other cost-sharing requirement or additional charge. Sec V.S.A. 4100g(d) is amended to read: (d) Benefits provided shall cover the colorectal cancer screening subject to a co-payment no greater than the co-payment applicable to care or services provided by a primary care physician under the insured s policy, provided that no co-payment shall exceed $ for services performed under contract with the insurer. Colorectal cancer screening services performed under contract with the insurer also shall not be subject to any co-payment, deductible, or coinsurance requirements, or other cost-sharing requirement. In addition, an insured shall not be subject to any additional charge for any service associated with a procedure or test for colorectal cancer screening, which may include one or more of the following: (1) removal of tissue or other matter; (2) laboratory services;
6 No. 25 Page 6 of 6 (3) physician services; (4) facility use; and (5) anesthesia. Sec. 6. EFFECTIVE DATES (a) Secs. 4 and 5 of this act shall take effect on October 1, 2013 and shall apply to all health benefit plans on and after October 1, 2013 on such date as a health insurer offers, issues, or renews the health benefit plan, but in no event later than October 1, (b) The remaining sections of this act shall take effect on passage. Date the Governor signed the bill: May 13, 2013
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[Third Reprint] SENATE, No. STATE OF NEW JERSEY th LEGISLATURE PRE-FILED FOR INTRODUCTION IN THE 0 SESSION Sponsored by: Senator LORETTA WEINBERG District (Bergen) Senator NIA H. GILL District (Essex and
Individual Deductible* $950 $950. Family Deductible* $1,900 $1,900
Schedule of Benefits Employer: The Vanguard Group, Inc. ASA: 697478-A Issue Date: January 22, 2018 Effective Date: January 1, 2018 Schedule: 3B Booklet Base: 3 For: Choice POS II - $950 Option - Retirees
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SU Pro (In- and Out-of-) In - Out -of- Cost Sharing Definitions Annual Deductible 1 Coinsurance Annual Out-of-Pocket Maximum 2 $200 per individual with a maximum of $400 for a family 5% of allowable amount
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PLAN FEATURES Deductible (per calendar year) $3,000 Individual $6,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. The Individual Deductible can only be
NETWORK CARE. $1,000 Individual $2,000 Family
PLAN FEATURES Network Managed Choice POS (Open Access) Primary Care Physician Selection Not Applicable Deductible (per calendar year) $3,500 Individual $7,000 Family Unless otherwise indicated, the Deductible
Up-to-date information regarding our compensation practices can be found in the Disclosures section of our website: tebcs.com
CancerSelect Plus Cancer-only indemnity insurance Underwritten by PHOTO: TWENTY20.COM/ORSOLYA SZABO Nancy watched as a co-worker battled lung cancer. Everyone rallied around him for support, but he still
$14,000 Family. $7,000 Individual. $14,000 Family
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Personal Choice 80. BlueCross BlueShield of North Dakota. Excluding benefits for routine maternity and delivery services.
Personal Choice 80 Excluding benefits for routine maternity and delivery services. BlueCross BlueShield of North Dakota An independent licensee of the Blue Cross & Blue Shield Association PC 80 Individual
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For: 80/20 Plan for Retired Employees Over Age 65 and Dependents
Schedule of Benefits Employer: Cornell University ASC: 397366 Issue Date: September 1, 2010 Effective Date: September 1, 2010 Schedule: 11A Booklet Base: 11 For: 80/20 Plan for Retired Employees Over Age
Not Applicable. $5,000 Individual. All covered expenses accumulate separately toward the Network and Out-of-Network Coinsurance Maximum.
PLAN FEATURES Network Managed Choice POS (Open Access) Primary Care Physician Selection Deductible (per calendar year) Not Applicable $2,000 per member Not Applicable $2,000 per member (2-member maximum)
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SUMMARY OF BENEFITS January 1, 2017 - December 31, 2017 Cigna-HealthSpring Preferred (HMO) H0354-001 Our service area includes the following counties in Arizona: Maricopa and Pinal* * denotes partial county:
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Fireside Contracting Services, LLC dba Fireside Home Solutions. Passport $5,000 Deductible
Fireside Contracting Services, LLC dba Fireside Home Solutions Passport $5,000 Deductible 4005403 HOW TO CONTACT US Please call or write Our Customer Service staff for help with the following: Questions
IN-NETWORK MEMBER PAYS OUT-OF-NETWORK MEMBER PAYS. Calendar Year Plan Deductible. services and prescription drugs) Out-of-Pocket Maximum
POS HDHP $3,000/$6,000 Deductible-F Point-of-Service Open Access High Deductible Health Plan for use with a Health Savings Account (HSA) Benefit Summary This is a brief summary of benefits. Refer to your
Summary of Benefits Prominence HealthFirst Small Group Health Plan
HealthFirst/ Calendar Year Deductible (CYD) 2 $1,000 Single / $3,000 Family Summary of Benefits $3,000 Single / $9,000 Family Coinsurance - Member responsibility 30% coinsurance 50% coinsurance Out-of-Pocket
Traditional Choice (Indemnity) (08/12)
PLAN FEATURES Network Primary Care Physician Selection Deductible (per calendar year) Not Applicable Not Applicable $500 Individual (2-member maximum) Unless otherwise indicated, the Deductible must be