Health insurance; require policies to cover Cologuard colorectal cancer screening tests.

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To: Public Health and Human
Services; Appropriations A
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representative Felsher

HOUSE BILL NO. 1061

AN ACT TO REQUIRE CERTAIN INSURANCE POLICIES AND CONTRACTS TO 1
PROVIDE COVERAGE FOR COLOGUARD COLORECTAL CANCER SCREENING TESTS; 2
TO AMEND SECTION 25-15-9, MISSISSIPPI CODE OF 1972, TO REQUIRE THE 3
STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE PLAN TO INCLUDE 4
COVERAGE FOR COLOGUARD COLORECTAL CANCER SCREENING TESTS; AND FOR 5
RELATED PURPOSES. 6
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 7
SECTION 1. (1) An individual and group health insurance 8
policy providing coverage on an expense-incurred basis, individual 9
and group service or indemnity type contract issued by a nonprofit 10
corporation, individual and group service contract issued by a 11
health maintenance organization, self-insured group arrangement to 12
the extent not preempted by federal law, and a managed health care 13
delivery entity of any type or description that is delivered, 14
issued for delivery, continued or renewed on or after July 1, 15
2026, and providing coverage to a resident of this state must 16
provide coverage or benefits for an Cologuard colorectal cancer 17
screening tests. The coverage required under this section must 18
meet the requirements set forth in subsection (2) of this section. 19
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(2) An individual may not be required to pay an additional 20
deductible or coinsurance for a Cologuard colorectal cancer 21
screening test which is greater than an annual deductible or 22
coinsurance established for similar benefits. If the program or 23
contract does not cover a similar benefit, a deductible or 24
coinsurance may not be set at a level that materially diminishes 25
the value of the Cologuard colorectal cancer screening test. 26
Reimbursement to a health care provider for a Cologuard colorectal 27
cancer screening test provided under this section must be equal to 28
or greater than reimbursement to a health care provider provided 29
under Title XVII of the Social Security Act (Medicare). 30
(3) A group health plan or health insurance issuer is not 31
required under this section to provide for a referral to a 32
nonparticipating health care provider unless the plan or issuer 33
does not have an appropriate health care provider that is 34
available and accessible to prescribe the Cologuard colorectal 35
cancer screening test and that is a participating health care 36
provider with respect to that treatment. 37
(4) If a plan or issuer refers an individual to a 38
nonparticipating health care provider in accordance with this 39
section, the Cologuard colorectal cancer screening test and 40
resulting treatment, if any, must be provided at no additional 41
cost to the individual beyond what the individual would otherwise 42
pay the same for services received from a participating health 43
care provider. 44
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SECTION 2. Section 25-15-9, Mississippi Code of 1972, is 45
amended as follows: 46
25-15-9. (1) (a) The board shall design a plan of health 47
insurance for state employees that provides benefits for 48
semiprivate rooms in addition to other incidental coverages that 49
the board deems necessary. The amount of the coverages shall be 50
in such reasonable amount as may be determined by the board to be 51
adequate, after due consideration of current health costs in 52
Mississippi. The plan shall also include major medical benefits 53
in such amounts as the board determines. The plan shall provide 54
for coverage for telemedicine services as provided in Section 55
83-9-351. The plan also must include coverage for Cologuard 56
colorectal cancer screening tests. The board is also authorized 57
to accept bids for such alternate coverage and optional benefits 58
as the board deems proper. The board is authorized to accept bids 59
for surgical services that include assistance in locating a 60
surgeon, setting up initial consultation, travel, a negotiated 61
single case rate bundle and payment for orthopedic, spine, 62
bariatric, cardiovascular and general surgeries. The surgical 63
services may only utilize surgeons and facilities located in the 64
State of Mississippi unless otherwise provided by the board. Any 65
contract for alternative coverage and optional benefits shall be 66
awarded by the board after it has carefully studied and evaluated 67
the bids and selected the best and most cost-effective bid. The 68
board may reject all of the bids; however, the board shall notify 69
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all bidders of the rejection and shall actively solicit new bids 70
if all bids are rejected. The board may employ or contract for 71
such consulting or actuarial services as may be necessary to 72
formulate the plan, and to assist the board in the preparation of 73
specifications and in the process of advertising for the bids for 74
the plan. Those contracts shall be solicited and entered into in 75
accordance with Section 25-15-5. The board shall keep a record of 76
all persons, agents and corporations who contract with or assist 77
the board in preparing and developing the plan. The board in a 78
timely manner shall provide copies of this record to the members 79
of the advisory council created in this section and those 80
legislators, or their designees, who may attend meetings of the 81
advisory council. The board shall provide copies of this record 82
in the solicitation of bids for the administration or servicing of 83
the self-insured program. Each person, agent or corporation that, 84
during the previous fiscal year, has assisted in the development 85
of the plan or employed or compensated any person who assisted in 86
the development of the plan, and that bids on the administration 87
or servicing of the plan, shall submit to the board a statement 88
accompanying the bid explaining in detail its participation with 89
the development of the plan. This statement shall include the 90
amount of compensation paid by the bidder to any such employee 91
during the previous fiscal year. The board shall make all such 92
information available to the members of the advisory council and 93
those legislators, or their designees, who may attend meetings of 94
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the advisory council before any action is taken by the board on 95
the bids submitted. The failure of any bidder to fully and 96
accurately comply with this paragraph shall result in the 97
rejection of any bid submitted by that bidder or the cancellation 98
of any contract executed when the failure is discovered after the 99
acceptance of that bid. The board is authorized to promulgate 100
rules and regulations to implement the provisions of this 101
subsection. 102
The board shall develop plans for the insurance plan 103
authorized by this section in accordance with the provisions of 104
Section 25-15-5. 105
Any corporation, association, company or individual that 106
contracts with the board for the third-party claims administration 107
of the self-insured plan shall prepare and keep on file an 108
explanation of benefits for each claim processed. The explanation 109
of benefits shall contain such information relative to each 110
processed claim that the board deems necessary, and, at a minimum, 111
each explanation shall provide the claimant's name, claim number, 112
provider number, provider name, service dates, type of services, 113
amount of charges, amount allowed to the claimant and reason 114
codes. The information contained in the explanation of benefits 115
shall be available for inspection upon request by the board. The 116
board shall have access to all claims information utilized in the 117
issuance of payments to employees and providers. 118
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(b) There is created an advisory council to advise the 119
board in the formulation of the State and School Employees Health 120
Insurance Plan. The council shall be composed of the * * * 121
Commissioner of Insurance * * *, or his designee, an 122
employee-representative of the state institutions of higher 123
learning appointed by the board of trustees thereof, an 124
employee-representative of the Mississippi Department of 125
Transportation appointed by the director thereof, an 126
employee-representative of the Department of Revenue appointed by 127
the Commissioner of Revenue, an employee-representative of 128
the * * * State Department of Health appointed by the State Health 129
Officer, an employee-representative of the Mississippi Department 130
of Corrections appointed by the Commissioner of Corrections, and 131
an employee-representative of the Department of Human Services 132
appointed by the Executive Director of Human Services, two 133
(2) * * * licensed public school administrators appointed by the 134
State Board of Education, two (2) * * * licensed classroom 135
teachers appointed by the State Board of Education, a * * * 136
nonlicensed school employee appointed by the State Board of 137
Education and a community * * * or junior college employee 138
appointed by the Mississippi Community College Board. 139
The Lieutenant Governor may designate the Secretary of the 140
Senate, the Chairman of the Senate Appropriations Committee, the 141
Chairman of the Senate Education Committee and the Chairman of the 142
Senate Insurance Committee, and the Speaker of the House of 143
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Representatives may designate the Clerk of the House, the Chairman 144
of the House Appropriations Committee, the Chairman of the House 145
Education Committee and the Chairman of the House Insurance 146
Committee, to attend any meeting of the State and School Employees 147
Insurance Advisory Council. The appointing authorities may 148
designate an alternate member from their respective houses to 149
serve when the regular designee is unable to attend the meetings 150
of the council. Those designees shall have no jurisdiction or 151
vote on any matter within the jurisdiction of the council. For 152
attending meetings of the council, the legislators shall receive 153
per diem and expenses, which shall be paid from the contingent 154
expense funds of their respective houses in the same amounts as 155
provided for committee meetings when the Legislature is not in 156
session; however, no per diem and expenses for attending meetings 157
of the council will be paid while the Legislature is in session. 158
No per diem and expenses will be paid except for attending 159
meetings of the council without prior approval of the proper 160
committee in their respective houses. 161
(c) No change in the terms of the State and School 162
Employees Health Insurance Plan may be made effective unless the 163
board, or its designee, has provided notice to the State and 164
School Employees Health Insurance Advisory Council and has called 165
a meeting of the council at least fifteen (15) days before the 166
effective date of the change. If the State and School Employees 167
Health Insurance Advisory Council does not meet to advise the 168
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board on the proposed changes, the changes to the plan shall 169
become effective at such time as the board has informed the 170
council that the changes shall become effective. 171
(d) Medical benefits for retired employees and 172
dependents under age sixty-five (65) years and not eligible for 173
Medicare benefits. For employees who retire before July 1, 2005, 174
and for employees retiring due to work-related disability under 175
the Public Employees' Retirement System, the same health insurance 176
coverage as for all other active employees and their dependents 177
shall be available to retired employees and all dependents under 178
age sixty-five (65) years who are not eligible for Medicare 179
benefits, the level of benefits to be the same level as for all 180
other active participants. For employees who retire on or after 181
July 1, 2005, and not retiring due to work-related disability 182
under the Public Employees' Retirement System, the same health 183
insurance coverage as for all other active employees and their 184
dependents shall be available to those retiring employees and all 185
dependents under age sixty-five (65) years who are not eligible 186
for Medicare benefits only if the retiring employees were 187
participants in the State and School Employees Health Insurance 188
Plan for four (4) years or more before their retirement, the level 189
of benefits to be the same level as for all other active 190
participants. This section will apply to those employees who 191
retire due to one hundred percent (100%) medical disability as 192
well as those employees electing early retirement. 193
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(e) Medical benefits for retired employees and 194
dependents over age sixty-five (65) years or otherwise eligible 195
for Medicare benefits. For employees who retire before July 1, 196
2005, and for employees retiring due to work-related disability 197
under the Public Employees' Retirement System, the health 198
insurance coverage available to retired employees over age 199
sixty-five (65) years or otherwise eligible for Medicare benefits, 200
and all dependents over age sixty-five (65) years or otherwise 201
eligible for Medicare benefits, shall be the major medical 202
coverage. For employees retiring on or after July 1, 2005, and 203
not retiring due to work-related disability under the Public 204
Employees' Retirement System, the health insurance coverage 205
described in this paragraph (e) shall be available to those 206
retiring employees only if they were participants in the State and 207
School Employees Health Insurance Plan for four (4) years or more 208
and are over age sixty-five (65) years or otherwise eligible for 209
Medicare benefits, and to all dependents over age sixty-five (65) 210
years or otherwise eligible for Medicare benefits. Benefits shall 211
be reduced by Medicare benefits as though the Medicare benefits 212
were the base plan. 213
All covered individuals shall be assumed to have full 214
Medicare coverage, Parts A and B; and any Medicare payments under 215
both Parts A and B shall be computed to reduce benefits payable 216
under this plan. 217
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(f) Lifetime maximum: The lifetime maximum amount of 218
benefits payable under the health insurance plan for each 219
participant is Two Million Dollars ($2,000,000.00). 220
(2) Nonduplication of benefits — reduction of benefits by 221
Title XIX benefits: When benefits would be payable under more 222
than one (1) group plan, benefits under those plans will be 223
coordinated to the extent that the total benefits under all plans 224
will not exceed the total expenses incurred. 225
Benefits for hospital or surgical or medical benefits shall 226
be reduced by any similar benefits payable in accordance with 227
Title XIX of the Social Security Act or under any amendments 228
thereto, or any implementing legislation. 229
Benefits for hospital or surgical or medical benefits shall 230
be reduced by any similar benefits payable by workers' 231
compensation. 232
No health care benefits under the state plan shall restrict 233
coverage for medically appropriate treatment prescribed by a 234
physician and agreed to by a fully informed insured, or if the 235
insured lacks legal capacity to consent by a person who has legal 236
authority to consent on his or her behalf, based on an insured's 237
diagnosis with a terminal condition. As used in this paragraph, 238
"terminal condition" means any aggressive malignancy, chronic 239
end-stage cardiovascular or cerebral vascular disease, or any 240
other disease, illness or condition which physician diagnoses as 241
terminal. 242
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Not later than January 1, 2016, the state health plan shall 243
not require a higher co-payment, deductible or coinsurance amount 244
for patient-administered anti-cancer medications, including, but 245
not limited to, those orally administered or self-injected, than 246
it requires for anti-cancer medications that are injected or 247
intravenously administered by a health care provider, regardless 248
of the formulation or benefit category determination by the plan. 249
For the purposes of this paragraph, the term "anti-cancer 250
medications" has the meaning as defined in Section 83-9-24. 251
(3) (a) Schedule of life insurance benefits — group term: 252
The amount of term life insurance for each active employee of a 253
department, agency or institution of the state government shall 254
not be in excess of One Hundred Thousand Dollars ($100,000.00), or 255
twice the amount of the employee's annual wage to the next highest 256
One Thousand Dollars ($1,000.00), whichever may be less, but in no 257
case less than Thirty Thousand Dollars ($30,000.00), with a like 258
amount for accidental death and dismemberment on a 259
twenty-four-hour basis. The plan will further contain a premium 260
waiver provision if a covered employee becomes totally and 261
permanently disabled before age sixty-five (65) years. Employees 262
retiring after June 30, 1999, shall be eligible to continue life 263
insurance coverage in an amount of Five Thousand Dollars 264
($5,000.00), Ten Thousand Dollars ($10,000.00) or Twenty Thousand 265
Dollars ($20,000.00) into retirement. 266
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(b) Effective October 1, 1999, schedule of life 267
insurance benefits — group term: The amount of term life 268
insurance for each active employee of any school district, 269
community * * * or junior college, public library or 270
university-based program authorized under Section 37-23-31 for 271
deaf, aphasic and emotionally disturbed children or any regular 272
nonstudent bus driver shall not be in excess of One Hundred 273
Thousand Dollars ($100,000.00), or twice the amount of the 274
employee's annual wage to the next highest One Thousand Dollars 275
($1,000.00), whichever may be less, but in no case less than 276
Thirty Thousand Dollars ($30,000.00), with a like amount for 277
accidental death and dismemberment on a twenty-four-hour basis. 278
The plan will further contain a premium waiver provision if a 279
covered employee of any school district, community * * * or junior 280
college, public library or university-based program authorized 281
under Section 37-23-31 for deaf, aphasic and emotionally disturbed 282
children or any regular nonstudent bus driver becomes totally and 283
permanently disabled before age sixty-five (65) years. Employees 284
of any school district, community * * * or junior college, public 285
library or university-based program authorized under Section 286
37-23-31 for deaf, aphasic and emotionally disturbed children or 287
any regular nonstudent bus driver retiring after September 30, 288
1999, shall be eligible to continue life insurance coverage in an 289
amount of Five Thousand Dollars ($5,000.00), Ten Thousand Dollars 290
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($10,000.00) or Twenty Thousand Dollars ($20,000.00) into 291
retirement. 292
(4) Any eligible employee who on March 1, 1971, was 293
participating in a group life insurance program that has 294
provisions different from those included in this article and for 295
which the State of Mississippi was paying a part of the premium 296
may, at his discretion, continue to participate in that plan. The 297
employee shall pay in full all additional costs, if any, above the 298
minimum program established by this article. Under no 299
circumstances shall any individual who begins employment with the 300
state after March 1, 1971, be eligible for the provisions of this 301
subsection. 302
(5) The board may offer medical savings accounts as defined 303
in Section 71-9-3 as a plan option. 304
(6) Any premium differentials, differences in coverages, 305
discounts determined by risk or by any other factors shall be 306
uniformly applied to all active employees participating in the 307
insurance plan. It is the intent of the Legislature that the 308
state contribution to the plan be the same for each employee 309
throughout the state. 310
(7) On October 1, 1999, any school district, community * * * 311
or junior college district or public library may elect to remain 312
with an existing policy or policies of group life insurance with 313
an insurance company approved by the State and School Employees 314
Health Insurance Management Board, in lieu of participation in the 315
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State and School Life Insurance Plan. On or after July 1, 2004, 316
until October 1, 2004, any school district, community * * * or 317
junior college district or public library may elect to choose a 318
policy or policies of group life insurance existing on October 1, 319
1999, with an insurance company approved by the State and School 320
Employees Health Insurance Management Board in lieu of 321
participation in the State and School Life Insurance Plan. The 322
state's contribution of up to fifty percent (50%) of the active 323
employee's premium under the State and School Life Insurance Plan 324
may be applied toward the cost of coverage for full-time employees 325
participating in the approved life insurance company group plan. 326
For purposes of this subsection (7), "life insurance company group 327
plan" means a plan administered or sold by a private insurance 328
company. After October 1, 1999, the board may assess charges in 329
addition to the existing State and School Life Insurance Plan 330
rates to such employees as a condition of enrollment in the State 331
and School Life Insurance Plan. In order for any life insurance 332
company group plan to be approved by the State and School 333
Employees Health Insurance Management Board under this subsection 334
(7), it shall meet the following criteria: 335
(a) The insurance company offering the group life 336
insurance plan shall be rated "A-" or better by A.M. Best state 337
insurance rating service and be licensed as an admitted carrier in 338
the State of Mississippi by the Mississippi Department of 339
Insurance. 340
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ST: Health insurance; require policies to cover
Cologuard colorectal cancer screening tests.
(b) The insurance company group life insurance plan 341
shall provide the same life insurance, accidental death and 342
dismemberment insurance and waiver of premium benefits as provided 343
in the State and School Life Insurance Plan. 344
(c) The insurance company group life insurance plan 345
shall be fully insured, and no form of self-funding life insurance 346
by the company shall be approved. 347
(d) The insurance company group life insurance plan 348
shall have one (1) composite rate per One Thousand Dollars 349
($1,000.00) of coverage for active employees regardless of age and 350
one (1) composite rate per One Thousand Dollars ($1,000.00) of 351
coverage for all retirees regardless of age or type of retiree. 352
(e) The insurance company and its group life insurance 353
plan shall comply with any administrative requirements of the 354
State and School Employees Health Insurance Management Board. If 355
any insurance company providing group life insurance benefits to 356
employees under this subsection (7) fails to comply with any 357
requirements specified in this subsection or any administrative 358
requirements of the board, the state shall discontinue providing 359
funding for the cost of that insurance. 360
SECTION 3. This act shall take effect and be in force from 361
and after July 1, 2026. 362