Section 1367.64 Of Article 5. Standards From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 5.
1367.64
. (a) Every individual or group health care service plan
contract, except for a specialized health care service plan contract,
that is issued, amended, or renewed on or after January 1, 1999,
shall be deemed to provide coverage for the screening and diagnosis
of prostate cancer, including, but not limited to, prostate-specific
antigen testing and digital rectal examinations, when medically
necessary and consistent with good professional practice.
(b) Nothing in this section shall be construed to establish a new
mandated benefit or to prevent application of deductible or copayment
provisions in a policy or plan, nor shall this section be construed
to require that a policy or plan be extended to cover any other
procedures under an individual or a group health care service plan
contract. Nothing in this section shall be construed to authorize an
enrollee to receive the services required to be covered by this
section if those services are furnished by a nonparticipating
provider, unless the enrollee is referred to that provider by a
participating physician or nurse practitioner providing care.