25 LC 46 1057
House Bill 373
By: Representatives Glaize of the 67
th
, Newton of the 127
th
, Cooper of the 45
th
, Mitchell of
the 88
th
, Paris of the 142
nd
, and others
A BILL TO BE ENTITLED
AN ACT
To amend Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated,
1
relating to general provisions regarding insurance, so as to require major medical coverage2
for annual prostate cancer screenings for certain men; to amend Part 1 of Article 1 of3
Chapter 18 of Title 45 of the Official Code of Georgia Annotated, relating to state employees'4
health insurance plan, so as to require coverage for annual prostate cancer screenings for5
certain men; to amend Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia6
Annotated, relating to medical assistance generally, so as to require coverage for annual7
prostate cancer screenings for certain men; to provide for a plan amendment when necessary;8
to provide for definitions; to provide for related matters; to provide for an effective date and9
applicability; to repeal conflicting laws; and for other purposes.10
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:11
SECTION 1.12
Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to13
general provisions regarding insurance, is amended by adding a new Code section to read as14
follows:15
H. B. 373
- 1 - 25 LC 46 1057
"33-24-59.34.16
(a) As used in this Code section, the term:17
(1) 'Cost sharing requirement' means a deductible, coinsurance, copayment, or a18
maximum limitation on the application of a deductible, coinsurance, copayment, or other19
out-of-pocket expense.20
(2) 'Health benefit policy' means any individual or group plan, policy, or contract for21
healthcare services issued, delivered, issued for delivery, or renewed in this state which22
provides major medical benefits by a healthcare corporation, health maintenance23
organization, preferred provider organization, accident and sickness insurer, fraternal24
benefit society, hospital service corporation, medical service corporation, or other insurer25
or similar entity.26
(3) 'Men with a family history of prostate cancer' means men who have a first-degree27
relative:28
(A) Who has been diagnosed with prostate cancer;29
(B) Who developed prostate cancer;30
(C) Whose death was a result of prostate cancer;31
(D) Who has been diagnosed with a cancer known to be associated with an increased32
risk of prostate cancer; or33
(E) Who has a genetic alteration known to be associated with an increased risk of34
prostate cancer.35
(4) 'Men with a high risk for prostate cancer' means:36
(A) Men who are 40 to 49 years of age with a family history of prostate cancer;37
(B) Men who are 50 years of age and older; and38
(C) Other men, as may be determined by a physician.39
(b) A health benefit policy shall provide coverage for annual prostate cancer screenings40
for men with a high risk for prostate cancer. Such coverage shall include a digital rectal41
examination and a prostate-specific antigen test.42
H. B. 373
- 2 - 25 LC 46 1057
(c)(1) Except as provided in paragraph (2) of this subsection, a health benefit policy that43
provides coverage for annual prostate cancer screenings shall provide such coverage44
without imposing a cost sharing requirement on the enrollee.45
(2) If compliance with paragraph (l) of this subsection would result in a high deductible46
health benefit policy with a health savings account becoming ineligible under Section 23347
of Title 26 of the Internal Revenue Code, then paragraph (l) of this subsection shall apply48
to such policy only after the policy enrollee has satisfied the minimum deductible49
required under such section of the Internal Revenue Code except with respect to items or50
services that are deemed preventive care pursuant to 26 U.S.C. Section 223(c)(2)(C) of51
the Internal Revenue Code, as such sections of Title 26 of the Internal Revenue Code are52
in effect on January 1, 2025, or as the Commissioner shall determine necessary."53
SECTION 2.54
Part 1 of Article 1 of Chapter 18 of Title 45 of the Official Code of Georgia Annotated,55
relating to state employees' health insurance plan, is amended by adding a new Code section56
to read as follows: 57
"45-18-4.2.58
(a) As used in this Code section, the term:59
(1) 'Cost sharing requirement' means a deductible, coinsurance, copayment, or a60
maximum limitation on the application of a deductible, coinsurance, copayment, or other61
out-of-pocket expense.62
(2) 'Men with a family history of prostate cancer' means men who have a first-degree63
relative:64
(A) Who has been diagnosed with prostate cancer;65
(B) Who developed prostate cancer;66
(C) Whose death was a result of prostate cancer;67
H. B. 373
- 3 - 25 LC 46 1057
(D) Who has been diagnosed with a cancer known to be associated with an increased68
risk of prostate cancer; or69
(E) Who has a genetic alteration known to be associated with an increased risk of70
prostate cancer.71
(3) 'Men with a high risk for prostate cancer' means:72
(A) Men who are 40 to 49 years of age with a family history of prostate cancer;73
(B) Men who are 50 years of age and older; and74
(C) Other men, as may be determined by a physician.75
(b) The health insurance plan established pursuant to this article shall include coverage for76
annual prostate cancer screenings for men with a high risk for prostate cancer. Such77
coverage shall include a digital rectal examination and a prostate-specific antigen test.78
(c)(1) Except as provided in paragraph (2) of this subsection, a health insurance plan that79
provides coverage for annual prostate cancer screenings shall provide such coverage80
without imposing a cost sharing requirement on the enrollee.81
(2) If compliance with paragraph (l) of this subsection would result in a high deductible82
health insurance plan established pursuant to this article with a health savings account83
becoming ineligible under Section 233 of Title 26 of the Internal Revenue Code, then84
paragraph (l) of this subsection shall apply to such plan only after the plan enrollee has85
satisfied the minimum deductible required under such section of the Internal Revenue86
Code except with respect to items or services that are deemed preventive care pursuant87
to 26 U.S.C. Section 223(c)(2)(C) of the Internal Revenue Code, as such sections of88
Title 26 of the Internal Revenue Code are in effect on January 1, 2025, or as the89
Commissioner of the Department of Community Health shall determine necessary."90
SECTION 3.91
Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to92
medical assistance generally, is amended by adding a new Code section to read as follows:93
H. B. 373
- 4 - 25 LC 46 1057
"49-4-159.5.94
(a) As used in this Code section, the term:95
(1) 'Cost sharing requirement' means a deductible, coinsurance, copayment, or a96
maximum limitation on the application of a deductible, coinsurance, copayment, or other97
out-of-pocket expense.98
(2) 'Men with a family history of prostate cancer' means men who have a first-degree99
relative:100
(A) Who has been diagnosed with prostate cancer;101
(B) Who developed prostate cancer;102
(C) Whose death was a result of prostate cancer;103
(D) Who has been diagnosed with a cancer known to be associated with an increased104
risk of prostate cancer: or105
(E) Who has a genetic alteration known to be associated with an increased risk of106
prostate cancer.107
(3) 'Men with a high risk for prostate cancer' means:108
(A) Men who are 40 to 49 years of age with a family history of prostate cancer;109
(B) Men who are 50 years of age and older; and110
(C) Other men, as may be determined by a physician.111
(b) The department shall provide Medicaid recipients who are men with a high risk for112
prostate cancer with coverage for annual prostate screenings and do so without imposing113
a cost sharing requirement on the enrollee. Such coverage shall include a digital rectal114
examination and a prostate-specific antigen test.115
(c) To implement the provisions of this Code section, the department shall, when116
necessary, submit a Medicaid state plan amendment or waiver request to the United States117
Department of Health and Human Services."118
H. B. 373
- 5 - 25 LC 46 1057
SECTION 4.
119
This Act shall become effective upon its approval by the Governor or upon its becoming law120
without such approval and shall apply to all applicable insurance policies issued, delivered,121
issued for delivery, or renewed on or after January 1, 2026.122
SECTION 5.123
All laws and parts of laws in conflict with this Act are repealed.124
H. B. 373
- 6 -