The Office of the Commissioner of Insurance (OCI) is issuing this bulletin to ensure all carriers continue to annually monitor and select one or more of the updated colorectal cancer screening guidelines issued by the U.S. Preventive Services Task Force, the National Cancer Institute, or the American Cancer Society as a basis for coverage of preventive colorectal cancer screening tests and procedures in accordance with s. 632.895 (16m), Wis. Stat., and s. Ins 3.35, Wis. Adm. Code.
Current regulation requires insurers to utilize one or more of the guidelines listed above to define covered benefits and to implement any modifications to the recommended tests or procedures to be effective the first day of the subsequent plan year. In addition, the types of medically appropriate or medically necessary covered screening tests or procedures shall at least include three of four tests or procedures contained in s. Ins 3.35 (4) (b), Wis. Adm. Code. This requirement does not preclude coverage by insurers of additional evidence-based recommended preventive colorectal screening tests or procedures.
Section Ins 3.35 (3) (b), Wis. Adm. Code, requires that insurers no less than annually review the designated guidelines for modifications and additions and update the benefits offered for the detection of colorectal cancer to be reflective of the guideline standards selected by the insurer. This will ensure that consumers are receiving the most up-to-date preventative cancer screenings that have been determined to be effective in early detection of colon cancer. Insurers shall comply with cost-sharing requirements outlined in s. 632.895 (16m), Wis. Stat., and s. 45 CFR 147.130.
This guidance is being shared with all insurers authorized to write health insurance coverage to continue Wisconsin's strong, level and competitive market.
Any questions concerning this bulletin should be directed to Diane Dambach at
diane.dambach@wisconsin.gov.