KRS 304.17A-264: Coverage under health benefit plan for cancer screening, test, or

procedure.

(1) As used in this section:

(a) "Cancer screening, test, or procedure" means any preventive screening, test,

or procedure performed for the purpose of det ecting cancer, including but not

limited to lung, breast, cervical, prostate, and colorectal cancer; and

(b) "Health benefit plan" has the same meaning as in KRS 304.17A -005, except

that for purposes of this section the term includes:

1. Short-term limited duration coverage; and

2. Student health insurance offered by a Kentucky -licensed insurer under

written contract with a university or college whose students it proposes

to insure.

(2) Except as provided in subsection (3) of this section:

(a) All health benefit plans shall provide coverage for:

1. Any cancer screening, test, or procedure that is required under federal

law, including but not limited to 42 U.S.C. sec. 300gg -13, as amended;

and

2. Any other cancer screening, test, or procedure that is:

a. Consistent with nationally recognized clinical practice guidelines,

including but not limited to:

i. The recommendations of the United States Preventive

Services Task Force;

ii. Clinical practice g uidelines established by the American

Cancer Society; and

iii. Clinical practice guidelines established by the National

Comprehensive Cancer Network; and

b. Ordered or prescribed by a health care provider legally authorized

to order or prescribe the cancer screening, test, or procedure; and

(b) The coverage required under this subsection shall not be subject to:

1. Utilization management requirements, including prior authorization,

except for the purpose of determining that the cancer screening, test, or

procedure meets the requirements of paragraph (a)2.a. of this

subsection; or

2. Any deductible, coinsurance, copayment, or other cost -sharing

requirement.

(3) (a) If the application of any requirement of subsection (2)(b)2. of this section

would be the sole cause of a health benefit plan's failure to qualify as a Health

Savings Account-qualified High Deductible Health Plan under 26 U.S.C. sec.

223, as amended, then the requirement shall not apply to that health benefit

plan until the minimum deductible under 26 U.S.C. sec. 223, as amended, is

satisfied.

(b) If the application of any requirement of subsection (2) of this section to a

qualified health plan as defined in 42 U.S.C. sec. 18021(a)(1), as amended,

would result in a determination that the state must m ake payments to defray

the cost of the requirement under 42 U.S.C. sec. 18031(d)(3) and 45 C.F.R.

sec. 155.170, as amended, then the requirement shall not apply to the qualified

health plan until the cost defrayal requirement is no longer applicable.

(4) (a) This section shall not be construed to limit coverage:

1. Provided under a health benefit plan; or

2. Required under any other law.

(b) In the case of a conflict between this section and any other law, this section

shall control unless application of th is section would result in a reduction of

coverage or benefits for any insured.