Health insurance; coverage requirements for prostate cancer screenings.
Summary
SB1314 amends Virginia’s health insurance and Medicaid statutes to add or update coverage requirements related to prostate cancer screening. The bill specifically requires coverage for PSA testing and digital rectal examinations for persons age 50 and over, and for persons age 40 and over who are at high risk for prostate cancer, consistent with American Cancer Society guidelines. It also revises the state employee health plan and the small-employer insurance mandate provisions so that prostate cancer screening is expressly included among the mandated benefits that must be covered.
The bill also makes conforming changes across several sections of the Code of Virginia, including the state employee health benefits statute, the Medicaid state plan statute, and the insurance mandate statute for individual and group policies. It adds prostate cancer screening to the list of services that must be covered without cost-sharing in most plans, while preserving the existing exception for high-deductible health plans that must remain compatible with health savings accounts. The bill applies to contracts, policies, or plans delivered, issued for delivery, or renewed in Virginia on or after January 1, 2026.
Impact
SB1314 directly affects state employee health coverage, Medicaid-related coverage requirements, and private health insurance policies subject to Virginia’s mandated-benefit laws. It amends 2.2-2818, 32.1-325, 38.2-3406.1, and 38.2-3418.7 to ensure prostate cancer screening is treated as a covered preventive service in those systems, and it updates cross-references so the new requirement is incorporated into existing benefit structures. The practical effect is to expand coverage obligations for insurers, the Department of Human Resource Management, and state-administered health plans, while leaving the HSA-compatible high-deductible plan exception intact.
Sentiment
The bill appears to have had overwhelmingly favorable support. It was reported from committee with unanimous votes, passed the Senate 38-0, and passed the House 94-0. No committee transcripts were provided, but the voting history indicates broad bipartisan agreement and little or no visible opposition during the legislative process.
Contention
There is little evidence of substantive contention in the available record. The only notable policy limitation is the continued exemption for high-deductible health plans that must preserve HSA eligibility, which reflects a standard compromise in mandated-benefit legislation. Otherwise, the bill’s coverage expansion for prostate cancer screening appears to have been noncontroversial, with support spanning both chambers and no recorded dissent in committee or floor votes.
Requires health care professional to order bi-lateral ultrasounds concurrently when ordering mammograms; requires insurers to cover concurrent mammograms and bi-lateral ultrasounds.
Requires health care professionals to order bi-lateral ultrasounds concurrently when ordering mammograms; requires insurers to cover concurrent mammograms and bi-lateral ultrasounds.