S 1019

South Carolina General Assembly
126th Session, 2025-2026
Bill 1019
Indicates Matter Stricken
Indicates New Matter
(Text matches printed bills. Document has been reformatted to meet World Wide Web specifications.)
A bill
TO AMEND THE SOUTH CAROLINA CODE OF LAWS BY AMENDING
SECTION 38-71-145, RELATING TO REQUIRED COVERAGE FOR MAMMOGRAMS, PAP SMEARS,
AND PROSTATE CANCER EXAMINATIONS AND LIMITATIONS, SO AS TO DEFINE TERMS,
REQUIRE HEALTH INSURANCE POLICIES IN THIS STATE TO ELIMINATE COST-SHARING
REQUIREMENTS FOR PROSTATE CANCER EXAMINATIONS, SCREENINGS, AND DIAGNOSTIC
LABORATORY, AND TO PROVIDE EXCEPTIONS CONCERNING THE APPLICATION OF CERTAIN
FEDERAL LAW.
Be it enacted by the
General Assembly of the State of South Carolina:
SECTION 1.  Section 38-71-145 of the S.C. Code is amended to read:
    Section
38-71-145. (A) For purposes of this section:
       (1) "Cost-sharing requirements" means
a deductible, coinsurance, copayment, and any maximum limitation on the
application of such a deductible, coinsurance, copayment, or similar
out-of-pocket expense.
       (2) "Health insurance policy" means a
health benefit plan, contract, or evidence of coverage providing health
insurance coverage as defined in Section 38-71-670(6) and Section
38-71-840(14).
       (3) "Mammogram" means a radiological
examination of the breast for purposes of detecting breast cancer when
performed as a result of a physician referral or by a health testing service
which utilizes radiological equipment approved by the Department of Public
Health, which examination may be made with the following minimum frequency:
  (a) once as a base-line mammogram for
a female who is at least thirty-five years of age but less than forty years of
age;
  (b) once every two years for a female
who is at least forty years of age but less than fifty years of age;
  (c) once a year for a female who is at
least fifty years of age; or
  (d) in accordance with the most recent
published guidelines of the American Cancer Society.
       (4) "Pap smear" means an examination
of the tissues of the cervix of the uterus for the purpose of detecting cancer
when performed upon the recommendation of a medical doctor, which examination
may be made once a year or more often if recommended by a medical doctor.
    (A)(B) All individual and group health insurance and health
maintenance organization policies in this State shall include coverage in the
policy for:
       (1)
mammograms;
       (2)
annual pap smears;
       (3)
prostate cancer examinations, screenings, and laboratory work for diagnostic
purposes in accordance with the most recent published guidelines of the American Cancer Society National
Comprehensive Cancer Network.
    (B)(C) The coverage required to be offered under subsectionsubsections (A)(B)(1) and (B)(2) may not
contain any exclusions, reductions, or other limitations as to coverages,
deductibles, or coinsurance provisions which apply to that coverage unless
these provisions apply generally to other similar benefits provided and paid
for under the health insurance policy.
    (D) A health insurance policy in this
State may not impose any cost-sharing requirements on prostate cancer
examinations, screenings, and laboratory work for diagnostic purposes furnished
to an individual enrolled in the plan under subsection (B)(3). If under federal
law the application of subsection (C) would result in a Health Savings Account
ineligibility under Section 223 of the Internal Revenue Code, then this
requirement only applies for Health Savings Account-qualified high deductible
health plans with respect to the deductible of such a plan after the enrollee
has satisfied the minimum deductible under Section 223, except with respect to
items or services that are preventative care pursuant to Section 223(c)(2)(C)
of the federal Internal Revenue Code, in which case the requirements of
subsection (C) apply regardless of whether or not the minimum deductible under
Section 223 has been satisfied.
    (C)(E) Nothing in this section prohibits a health insurance
policy from providing benefits greater than those required to be offered by
subsections (A)(B), and (B)(C), and (D) or more
favorable to the enrollee than those required to be offered by subsections (A)(B), and
(B)(C), and (D).
    (D)(F) This section applies to individual and group health
insurance policies issued by a fraternal benefit society, an insurer, a health
maintenance organization, or any similar entity, except as exempted by ERISA.
    (E) For purposes of this section:
       (1) "Mammogram" means a radiological
examination of the breast for purposes of detecting breast cancer when
performed as a result of a physician referral or by a health testing service
which utilizes radiological equipment approved by the Department of Health and
Environmental Control, which examination may be made with the following minimum
frequency:
  (a) once as a base-line mammogram for
a female who is at least thirty-five years of age but less than forty years of
age;
  (b) once every two years for a female
who is at least forty years of age but less than fifty years of age;
  (c) once a year for a female who is at
least fifty years of age;  or
  (d) in accordance with the most recent
published guidelines of the American Cancer Society.
       (2) "Pap smear" means an examination
of the tissues of the cervix of the uterus for the purpose of detecting cancer
when performed upon the recommendation of a medical doctor, which examination
may be made once a year or more often if recommended by a medical doctor.
       (3) "Health insurance policy" means a
health benefit plan, contract, or evidence of coverage providing health
insurance coverage as defined in Section 38-71-670(6) and Section
38-71-840(14).
SECTION 2.  This act takes effect upon approval
by the Governor.
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This web page was last updated on March 17, 2026 at 12:20 PM