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HB40 INTRODUCED
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HB40
ARHYR7Q-1
By Representative Gray
RFD: Insurance
First Read: 13-Jan-26
PFD: 28-Aug-25
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ARHYR7Q-1 06/26/2025 JC (L)lg 2025-2166
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PFD: 28-Aug-25
SYNOPSIS:
Under existing law, health insurance plans are
required to cover annual screening of men over 40 years
of age for the early detection of prostate cancer.
This bill would recognize that African American
men and men who have a first degree relative who has
had prostate cancer are at high risk for the disease.
This bill would also require that coverage for
screening of high-risk men and all older men be
provided without deductibles, copayments, or other
cost-sharing requirements.
A BILL
TO BE ENTITLED
AN ACT
Relating to insurance; to amend Sections 27-58-1 and
27-58-4, Code of Alabama 1975; to recognize that a higher risk
of prostate cancer exists in certain groups of men; and to
require health insurance plans to cover screening of both
younger high-risk men and all older men, free of out-of-pocket
costs.
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. Sections 27-58-1 and 27-58-4, Code of
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Section 1. Sections 27-58-1 and 27-58-4, Code of
Alabama 1975, are amended to read as follows:
"§27-58-1
As used in this chapter, the following terms shall have
the following meanings:
(1) COST-SHARING REQUIREMENTS. An annual deductible,
coinsurance, copayment, or other out-of-pocket expense imposed
on an insured as a condition for receiving a covered treatment
or service.
(1)(2) HEALTH BENEFIT PLAN. Any individual or group
plan, employee welfare benefit plan, policy, or contract for
health care services issued, delivered, issued for delivery,
or renewed in this state by a health care insurer, health
maintenance organization, accident and sickness insurer,
fraternal benefit society, nonprofit hospital service
corporation, nonprofit medical service corporation, health
care service plan, any plan or health benefits offered by a
nonprofit agricultural organization, or any other person,
firm, corporation, joint venture, or other similar business
entity that pays for insureds or beneficiaries in this state.
The term includes, but is not limited to, entities created
pursuant to Article 6 of Chapter 20 of Title 10A. A health
benefit plan located or domiciled outside of the State of
Alabama is deemed to be subject to this chapter if it
receives, processes, adjudicates, pays, or denies claims for
health care services submitted by or on behalf of patients,
insureds, or beneficiaries who reside in Alabama. Provided,
however, the term shall not include accident-only, specified
disease, hospital indemnity, Medicare supplement, long-term
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disease, hospital indemnity, Medicare supplement, long-term
care, disability income, or other limited benefit health
insurance policies.
(3) MEN AT HIGH RISK. Regardless of age, African
American men and men who have a father, brother, or son to
whom any of the following apply:
a. Received a diagnosis of prostate cancer.
b. Developed prostate cancer.
c. Death caused by prostate cancer.
d. Received a diagnosis of a cancer that is known to be
associated with a higher risk of prostate cancer.
e. Carries a genetic marker known to be associated with
an increased risk of prostate cancer.
(2)(4) SCREENING FOR THE EARLY DETECTION OF PROSTATE
CANCER. At a minimum, a prostate-specific antigen blood test
and a digital rectal examination."
"§27-58-4
(a) The benefits provided in this chapter shall be
subject to the same annual deductible or coinsurance
established cost-sharing requirements for all covered benefits
within a given policy , except that no cost-sharing
requirements shall be imposed on: (i) men over 50 years of
age; and (ii) men at high risk for prostate cancer who are
over 40 years of age . Private third party third-party payors
may not reduce or eliminate coverage due to the requirements
of this chapter.
(b) A health benefit plan subject to this chapter shall
not terminate services, reduce capitation payment, or
otherwise penalize an attending physician or health care
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otherwise penalize an attending physician or health care
provider who orders medical care consistent with this chapter.
(c) Nothing in this chapter is intended to expand the
list of designations of covered providers as specified in any
health benefit plan."
Section 2. This act shall become effective on October
1, 2026.
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