Tenn. Code Ann. § 56-7-2354: Coverage for early detection of prostrate cancer

(a) As used in this section: (1) "Cost sharing requirement" means a deductible, coinsurance, copayment, or a maximum limitation on the application of a deductible, coinsurance, copayment, or other out-of-pocket expense; (2) "Health benefit plan": (A) Means a hospital or medical expense policy; health, hospital, or medical service corporation contract; policy or agreement entered into by a health insurer; or health maintenance organization contract offered by an employer; (B) Includes a state insurance plan set out in title 8, chapter 27; a policy or contract for health insurance coverage provided under the TennCare medical assistance program or a successor program provided for in title 71, chapter 5; and a policy or contract for health insurance coverage provided under the CoverKids program or a successor program provided for in title 71, chapter 3; and (C) Does not include policies or certificates covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, as defined in § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ), specified disease, or vision care; other limited benefit health insurance; coverage issued as a supplement to liability insurance; workers' compensation insurance; automobile medical payment insurance; or insurance that is statutorily required to be contained in any liability insurance policy or equivalent self insurance; and (3) "Men with a family history of prostate cancer" means men who have a first-degree relative: (A) Who was diagnosed with prostate cancer; (B) Who developed prostate cancer; (C) Whose death was a result of prostate cancer; (D) Who has been diagnosed with a cancer known to be associated with an increased risk of prostate cancer; or (E) Who has a genetic alteration known to be associated with an increased risk of prostate cancer. (b) A health benefit plan shall provide, upon the recommendation of a physician, coverage for the early detection of prostate cancer for: (1) Men forty (40) to forty-nine (49) years of age who are at a high risk of developing prostate cancer, including African-American men and men with a family history of prostate cancer; (2) Men fifty (50) years of age and older; and (3) Other men, if a physician determines that early detection for prostate cancer is medically necessary. (c) (1) Except as provided in subdivision (c)(2), a health benefit plan that provides coverage for the early detection of prostate cancer must provide such coverage without imposing a cost sharing requirement on the enrollee. (2) If compliance with subdivision (c)(1) would result in a high deductible health benefit plan with a health savings account becoming ineligible under § 223 of the Internal Revenue Code ( 26 U.S.C. § 223 ), then subdivision (c)(1) applies to such plans only after the plan enrollee has satisfied the minimum deductible required under § 223 of the Internal Revenue Code, except with respect to items or services that are deemed preventive care pursuant to § 223(c)(2)(C) of the Internal Revenue Code. (d) Notwithstanding subsection (b), a policy or contract for health insurance coverage provided under the TennCare medical assistance program or a successor program provided for in title 71, chapter 5, or the CoverKids program or a successor program provided for in title 71, chapter 3, must provide coverage pursuant to this section when determined to be medically necessary pursuant to § 71-5-144 . Amended by 2024 Tenn. Acts, ch. 1003,s 2, eff. 7/1/2024. Acts 1997 , ch. 443, § 1.

age provided under the TennCare medical assistance program or a successor program provided for in title 71, chapter 5, or the CoverKids program or a successor program provided for in title 71, chapter 3, must provide coverage pursuant to this section when determined to be medically necessary pursuant to § 71-5-144 . Amended by 2024 Tenn. Acts, ch. 1003,s 2, eff. 7/1/2024. Acts 1997 , ch. 443, § 1.

(a) As used in this section: (1) "Cost sharing requirement" means a deductible, coinsurance, copayment, or a maximum limitation on the application of a deductible, coinsurance, copayment, or other out-of-pocket expense; (2) "Health benefit plan": (A) Means a hospital or medical expense policy; health, hospital, or medical service corporation contract; policy or agreement entered into by a health insurer; or health maintenance organization contract offered by an employer; (B) Includes a state insurance plan set out in title 8, chapter 27; a policy or contract for health insurance coverage provided under the TennCare medical assistance program or a successor program provided for in title 71, chapter 5; and a policy or contract for health insurance coverage provided under the CoverKids program or a successor program provided for in title 71, chapter 3; and (C) Does not include policies or certificates covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, as defined in § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ), specified disease, or vision care; other limited benefit health insurance; coverage issued as a supplement to liability insurance; workers' compensation insurance; automobile medical payment insurance; or insurance that is statutorily required to be contained in any liability insurance policy or equivalent self insurance; and (3) "Men with a family history of prostate cancer" means men who have a first-degree relative: (A) Who was diagnosed with prostate cancer; (B) Who developed prostate cancer; (C) Whose death was a result of prostate cancer; (D) Who has been diagnosed with a cancer known to be associated with an increased risk of prostate cancer; or (E) Who has a genetic alteration known to be associated with an increased risk of prostate cancer.

(1) "Cost sharing requirement" means a deductible, coinsurance, copayment, or a maximum limitation on the application of a deductible, coinsurance, copayment, or other out-of-pocket expense;

(2) "Health benefit plan": (A) Means a hospital or medical expense policy; health, hospital, or medical service corporation contract; policy or agreement entered into by a health insurer; or health maintenance organization contract offered by an employer; (B) Includes a state insurance plan set out in title 8, chapter 27; a policy or contract for health insurance coverage provided under the TennCare medical assistance program or a successor program provided for in title 71, chapter 5; and a policy or contract for health insurance coverage provided under the CoverKids program or a successor program provided for in title 71, chapter 3; and (C) Does not include policies or certificates covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, as defined in § 1882(g)(1) of the Social Security Act ( 42 U.S.C

le 71, chapter 5; and a policy or contract for health insurance coverage provided under the CoverKids program or a successor program provided for in title 71, chapter 3; and (C) Does not include policies or certificates covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, as defined in § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ), specified disease, or vision care; other limited benefit health insurance; coverage issued as a supplement to liability insurance; workers' compensation insurance; automobile medical payment insurance; or insurance that is statutorily required to be contained in any liability insurance policy or equivalent self insurance; and

(A) Means a hospital or medical expense policy; health, hospital, or medical service corporation contract; policy or agreement entered into by a health insurer; or health maintenance organization contract offered by an employer;

(B) Includes a state insurance plan set out in title 8, chapter 27; a policy or contract for health insurance coverage provided under the TennCare medical assistance program or a successor program provided for in title 71, chapter 5; and a policy or contract for health insurance coverage provided under the CoverKids program or a successor program provided for in title 71, chapter 3; and

(C) Does not include policies or certificates covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, as defined in § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ), specified disease, or vision care; other limited benefit health insurance; coverage issued as a supplement to liability insurance; workers' compensation insurance; automobile medical payment insurance; or insurance that is statutorily required to be contained in any liability insurance policy or equivalent self insurance; and

(3) "Men with a family history of prostate cancer" means men who have a first-degree relative: (A) Who was diagnosed with prostate cancer; (B) Who developed prostate cancer; (C) Whose death was a result of prostate cancer; (D) Who has been diagnosed with a cancer known to be associated with an increased risk of prostate cancer; or (E) Who has a genetic alteration known to be associated with an increased risk of prostate cancer.

(A) Who was diagnosed with prostate cancer;

(B) Who developed prostate cancer;

(C) Whose death was a result of prostate cancer;

(D) Who has been diagnosed with a cancer known to be associated with an increased risk of prostate cancer; or

(E) Who has a genetic alteration known to be associated with an increased risk of prostate cancer.

(b) A health benefit plan shall provide, upon the recommendation of a physician, coverage for the early detection of prostate cancer for: (1) Men forty (40) to forty-nine (49) years of age who are at a high risk of developing prostate cancer, including African-American men and men with a family history of prostate cancer; (2) Men fifty (50) years of age and older; and (3) Other men, if a physician determines that early detection for prostate cancer is medically necessary.

(1) Men forty (40) to forty-nine (49) years of age who are at a high risk of developing prostate cancer, including African-American men and men with a family history of prostate cancer;

(2) Men fifty (50) years of age and older; and

(3) Other men, if a physician determines that early detection for prostate cancer is medically necessary.

t early detection for prostate cancer is medically necessary.

(1) Men forty (40) to forty-nine (49) years of age who are at a high risk of developing prostate cancer, including African-American men and men with a family history of prostate cancer;

(2) Men fifty (50) years of age and older; and

(3) Other men, if a physician determines that early detection for prostate cancer is medically necessary.

(c) (1) Except as provided in subdivision (c)(2), a health benefit plan that provides coverage for the early detection of prostate cancer must provide such coverage without imposing a cost sharing requirement on the enrollee. (2) If compliance with subdivision (c)(1) would result in a high deductible health benefit plan with a health savings account becoming ineligible under § 223 of the Internal Revenue Code ( 26 U.S.C. § 223 ), then subdivision (c)(1) applies to such plans only after the plan enrollee has satisfied the minimum deductible required under § 223 of the Internal Revenue Code, except with respect to items or services that are deemed preventive care pursuant to § 223(c)(2)(C) of the Internal Revenue Code.

(1) Except as provided in subdivision (c)(2), a health benefit plan that provides coverage for the early detection of prostate cancer must provide such coverage without imposing a cost sharing requirement on the enrollee.

(2) If compliance with subdivision (c)(1) would result in a high deductible health benefit plan with a health savings account becoming ineligible under § 223 of the Internal Revenue Code ( 26 U.S.C. § 223 ), then subdivision (c)(1) applies to such plans only after the plan enrollee has satisfied the minimum deductible required under § 223 of the Internal Revenue Code, except with respect to items or services that are deemed preventive care pursuant to § 223(c)(2)(C) of the Internal Revenue Code.

(d) Notwithstanding subsection (b), a policy or contract for health insurance coverage provided under the TennCare medical assistance program or a successor program provided for in title 71, chapter 5, or the CoverKids program or a successor program provided for in title 71, chapter 3, must provide coverage pursuant to this section when determined to be medically necessary pursuant to § 71-5-144 .