Provides relative to health insurance coverage for prostate cancer screening. (gov sig)

Senate Bill 84 amends Louisiana Revised Statutes 22:1028 to modify the insurance coverage requirements for prostate cancer screening. The bill retains existing coverage for men over fifty years of age and modifies the coverage standard for men between forty and forty-nine years of age by replacing the "medically necessary and appropriate" standard with a requirement that coverage be provided in accordance with the most recently published guidelines from the National Comprehensive Cancer Network. Additionally, the bill expands the prohibition on cost-sharing by replacing language that prohibited only deductibles with broader language that prohibits any cost-sharing amount, including deductibles, coinsurance, copayments, or similar out-of-pocket expenses for prostate cancer screening services.

Health insurance carriers offering health coverage plans in Louisiana are directly affected by this legislation. For men between the ages of forty and forty-nine, the change from a "medically necessary and appropriate" standard to compliance with National Comprehensive Cancer Network guidelines will likely expand the population eligible for covered prostate cancer screening, as clinical guidelines typically recommend screening discussions with high-risk men in this age group rather than limiting coverage to individualized medical necessity determinations. Insurance carriers will be required to absorb the full cost of covered prostate cancer screening services without collecting any out-of-pocket expenses from covered individuals, which may increase their claims expenses. The provisions apply to new policies issued on or after January 1, 2027, and existing policies must comply by their renewal date no later than January 1, 2028.

The amendment operates within Louisiana's existing insurance code framework governing health coverage mandates. Louisiana Revised Statutes 22:1028 has previously established requirements that health coverage plans provide cancer screening services, and this bill refines those requirements by reference to an external clinical guideline from the National Comprehensive Cancer Network, a recognized national authority on cancer screening and treatment protocols. The statutory expansion of cost-sharing prohibitions aligns with broader preventive health principles reflected in federal law, including provisions of the Affordable Care Act that generally require coverage of preventive services without cost-sharing. The bill takes effect upon gubernatorial signature or expiration of the signature period, without requiring a specific future date, making it immediately operative once enacted.