2015 Oregon Revised Statutes
Volume : 16 - Financial Institutions, Insurance
Chapter 743A - Health Insurance: Reimbursement of Claims
Section 743A.124 - Colorectal cancer screenings and laboratory tests.

(1) An insurer offering a health insurance policy that covers hospital, medical or surgical expenses, other than coverage limited to expenses from accidents or specific diseases, shall provide coverage for all colorectal cancer screening examinations and laboratory tests assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.

(2) If an insured is 50 years of age or older, an insurer may not impose cost sharing on the coverage required by subsection (1) of this section and the coverage shall include, at a minimum:

(a) Fecal occult blood tests;

(b) Colonoscopies, including the removal of polyps during a screening procedure; or

(c) Double contrast barium enemas.

(3) If an insured is at high risk for colorectal cancer, the coverage required by subsection (1) of this section shall include colorectal cancer screening examinations and laboratory tests as recommended by the treating physician.

(4) For the purposes of subsection (3) of this section, an individual is at high risk for colorectal cancer if the individual has:

(a) A family medical history of colorectal cancer;

(b) A prior occurrence of cancer or precursor neoplastic polyps;

(c) A prior occurrence of a chronic digestive disease condition such as inflammatory bowel disease, Crohn’s disease or ulcerative colitis; or

(d) Other predisposing factors.

(5) Health care service contractors, as defined in ORS 750.005, and trusts carrying out a multiple employer welfare arrangement, as defined in ORS 750.301, are also subject to this section.

[Formerly 743.799; 2014 c.9 §1]

Note: The amendments to 743A.124 by section 1, chapter 206, Oregon Laws 2015, apply to plans issued or renewed on or after January 1, 2017. See section 2, chapter 206, Oregon Laws 2015. The text that applies to plans issued or renewed on or after January 1, 2017, is set forth for the user’s convenience.
(1) A health benefit plan, as defined in ORS 743B.005, shall provide coverage for all colorectal cancer screening examinations and laboratory tests assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.

(2) If an insured is 50 years of age or older, an insurer may not impose cost sharing on the coverage required by subsection (1) of this section and the coverage shall include, at a minimum:

(a)(A) Fecal occult blood tests;

(B) Colonoscopies, including the removal of polyps during a screening procedure; or

(C) Double contrast barium enemas; and

(b) A colonoscopy, including the removal of polyps during the procedure, if the insured has a positive result on any fecal test assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.

(3) If an insured is at high risk for colorectal cancer, the coverage required by subsection (1) of this section shall include colorectal cancer screening examinations and laboratory tests as recommended by the treating physician.

(4) For the purposes of subsection (3) of this section, an individual is at high risk for colorectal cancer if the individual has:

(a) A family medical history of colorectal cancer;

(b) A prior occurrence of cancer or precursor neoplastic polyps;

(c) A prior occurrence of a chronic digestive disease condition such as inflammatory bowel disease, Crohn’s disease or ulcerative colitis; or

(d) Other predisposing factors.

(5) Subsection (2)(b) of this section does not apply to a high deductible health plan described in 26 U.S.C. 223.

Note: See 743A.001.

Note: 743A.124 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.