The Office of the Commissioner of Insurance (OCI) is issuing this bulletin to ensure all carriers continue to review colorectal cancer screening guidelines issued by the U.S. Preventive Services Task Force, the National Cancer Institute, or the American Cancer Society which are used as a basis for coverage of 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 at least one 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 keeping with the requirements in s. 632.895 (16m), Wis. Stat., insurers shall "[P]eriodically update the guidelines . . . as medically appropriate." Insurers are required to provide coverage for all cancer screening tests or procedures if specific colorectal cancer screening tests or procedures are approved by the selected guideline and provide coverage for all cancer screening tests or procedures covered under Medicare. This requirement does not preclude coverage by insurers of additional evidence-based recommended 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 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.
Any questions concerning this bulletin should be directed to Diane Dambach at