effective date, may not require a waiting 
period. 
‘‘(2) COLORECTAL
CANCER
SCREENING
DE-
FINED.—For purposes of this section, the term 
‘colorectal cancer screening’ means procedures 
that— 
‘‘(A) are deemed appropriate by a physi-
cian (as defined in section 1861(r) of the Social 
Security Act (42 U.S.C. 1395x(r))) treating the 
participant or beneficiary, in consultation with 
the participant or beneficiary; 
‘‘(B) are— 
‘‘(i) described in section 1861(pp)(1) 
of the Social Security Act (42 U.S.C. 
1395x(pp)(1)) or section 410.37 of title 
42, Code of Federal Regulations; 
‘‘(ii) specified by the Secretary of 
Health and Human Services for the detec-
tion of colorectal cancer, based upon the 
recommendations of appropriate organiza-
tions with special expertise in the field of 
colorectal cancer, including the American 
Cancer Society and the American College 
of Gastroenterology; or 
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‘‘(iii) specified by the Secretary of 
Health and Human Services, based upon 
new scientific knowledge, technological ad-
vances, or other updated medical practices 
with respect to detection of colorectal can-
cer; and 
‘‘(C) are performed at a frequency not 
greater than— 
‘‘(i)(I) subject to subclause (II), that 
described for such method in section 
1834(d) of the Social Security Act (42 
U.S.C. 1395m(d)) or section 410.37 of 
title 42, Code of Federal Regulations; or 
‘‘(II) in the case of a colorectal cancer 
screening test consisting of a screening 
colonoscopy, once every 36 months; or 
‘‘(ii) that specified by the Secretary 
for such method, if the Secretary finds, 
based upon new scientific knowledge, tech-
nological advances, or other updated med-
ical practices and consistent with the rec-
ommendations of appropriate organizations 
with special expertise in the field of 
colorectal cancer, that a different fre-
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quency would not adversely affect the ef-
fectiveness of such screening. 
‘‘(b) PROTECTIONS.—A group health plan may not— 
‘‘(1) deny to an individual eligibility, or contin-
ued eligibility, to enroll or to renew coverage under 
the terms of the plan, solely for the purpose of 
avoiding the requirements of this section; 
‘‘(2) provide monetary payments or rebates to 
individuals to encourage such individuals to accept 
less than the minimum protections available under 
this section; 
‘‘(3) penalize or otherwise reduce or limit the 
reimbursement of a provider because such provider 
provided care to an individual participant or bene-
ficiary in accordance with this section; or 
‘‘(4) provide incentives (monetary or otherwise) 
to an attending provider to induce such provider to 
provide care to an individual participant or bene-
ficiary in a manner inconsistent with this section. 
‘‘(c) RULES OF CONSTRUCTION.— 
‘‘(1) Nothing in this section shall be construed 
to require an individual who is a participant or bene-
ficiary to undergo colorectal cancer screening. 
‘‘(2) Nothing in this section shall be construed 
as preventing a group health plan from imposing 
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deductibles, coinsurance, or other cost-sharing in re-
lation to colorectal cancer screening under the plan, 
except that such coinsurance or other cost-sharing 
shall not discriminate on any basis related to the 
coverage required under this section. 
‘‘(d) DISCLOSURE REQUIREMENT.— 
‘‘(1) IN
GENERAL.—A group health plan 
shall— 
‘‘(A) provide to participants and bene-
ficiaries at the time of initial coverage under 
the plan (or the effective date of this section, in 
the case of individuals who are participants or 
beneficiaries as of such date), and at least an-
nually thereafter, the information described in 
paragraph (2); 
‘‘(B) provide to participants and bene-
ficiaries, within a reasonable period (as speci-
fied by the appropriate Secretary) before or 
after the date of significant changes in the in-
formation described in paragraph (2), informa-
tion regarding such significant changes; and 
‘‘(C) upon request, make available to par-
ticipants and beneficiaries, the applicable au-
thority, and prospective participants and bene-
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ficiaries, the information described in para-
graph (2). 
‘‘(2) INFORMATION DESCRIBED.—For purposes 
of paragraph (1), the information described in this 
paragraph, with respect to colorectal cancer screen-
ing, is the following: 
‘‘(A) BENEFITS.—Benefits offered under 
the plan, including— 
‘‘(i) covered benefits, including benefit 
limits and coverage exclusions; 
‘‘(ii) cost-sharing, such as deductibles, 
coinsurance, and copayment amounts, in-
cluding any liability for balance billing, any 
maximum limitations on out of pocket ex-
penses, and the maximum out of pocket 
costs for services that are provided by non-
participating providers or that are fur-
nished without meeting the applicable utili-
zation review requirements; 
‘‘(iii) the extent to which benefits may 
be obtained from nonparticipating pro-
viders; and 
‘‘(iv) the extent to which a partici-
pant, beneficiary, or enrollee may select 
from among participating providers and 
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the types of providers participating in the 
plan or issuer network. 
‘‘(B) ACCESS.—A description of the fol-
lowing: 
‘‘(i) The number, mix, and distribu-
tion of providers under the plan. 
‘‘(ii) Out-of-network coverage (if any) 
provided by the plan. 
‘‘(iii) Any point-of-service option (in-
cluding any supplemental premium or cost- 
sharing for such option). 
‘‘(iv) The procedures for participants, 
beneficiaries, and enrollees to select, ac-
cess, and change participating primary and 
specialty providers. 
‘‘(v) The rights and procedures for 
obtaining referrals (including standing re-
ferrals) to participating and nonpartici-
pating providers. 
‘‘(vi) The name, address, and tele-
phone number of participating health care 
providers and an indication of whether 
each such provider is available to accept 
new patients. 
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‘‘(vii) How the plan or issuer address-
es the needs of participants, beneficiaries, 
and enrollees and others who do not speak 
English or who have other special commu-
nications needs in accessing providers 
under the plan, including the provision of 
information under this paragraph.’’. 
(B) The table of sections of such sub-
chapter of such Code is amended by inserting 
after the item relating to section 9813 the fol-
lowing new item: 
‘‘Sec. 9814. Coverage of colorectal cancer screening.’’. 
(C) Section 4980D(d)(1) of such Code is 
amended by striking ‘‘section 9811’’ and insert-
ing ‘‘sections 9811 and 9814’’. 
(b) INDIVIDUAL HEALTH INSURANCE.— 
(1) IN GENERAL.—Part B of title XXVII of the 
Public Health Service Act is amended by inserting 
after section 2753 the following new section: 
‘‘SEC. 2754. COVERAGE OF COLORECTAL CANCER SCREEN-
ING. 
‘‘(a) IN GENERAL.—The provisions of section 2708 
(other than subsection (d)) shall apply to health insurance 
coverage offered by a health insurance issuer in the indi-
vidual market in the same manner as it applies to health 
insurance coverage offered by a health insurance issuer 
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in connection with a group health plan in the small or 
large group market. 
‘‘(b) NOTICE.—A health insurance issuer under this 
part shall comply with the notice requirement under sec-
tion 715(d) of the Employee Retirement Income Security 
Act of 1974 with respect to the requirements referred to 
in subsection (a) as if such section applied to such issuer 
and such issuer were a group health plan.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
2762(b)(2) of such Act (42 U.S.C. 300gg–63(b)(2)) 
is amended by striking ‘‘section 2751’’ and inserting 
‘‘sections 2751 and 2754’’. 
(c) APPLICATION
UNDER
FEDERAL
EMPLOYEES 
HEALTH BENEFITS PROGRAM (FEHBP).—Section 8902 
of title 5, United States Code, is amended by adding at 
the end the following new subsection: 
‘‘(p) A contract may not be made or a plan approved 
which does not comply with the requirements of section 
2708 of the Public Health Service Act.’’. 
(d) EFFECTIVE DATES.— 
(1) GROUP HEALTH PLANS AND HEALTH BEN-
EFIT PLANS.—The amendments made by subsections 
(a) and (c) shall apply with respect to group health 
plans (and health insurance coverage offered in con-
nection with group health plans) and health benefit 
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plans, respectively, for plan years beginning on or 
after January 1, 2010. 
(2) INDIVIDUAL
HEALTH
INSURANCE.—The 
amendments made by subsection (b) shall apply with 
respect to health insurance coverage offered, sold, 
issued, or renewed in the individual market on or 
after January 1, 2010. 
(e) COORDINATION OF ADMINISTRATION.—The Sec-
retary of Health and Human Services, the Secretary of 
Labor, and the Secretary of the Treasury shall ensure, 
through the execution of an interagency memorandum of 
understanding among such Secretaries, that— 
(1) regulations, rulings, and interpretations 
issued by such Secretaries relating to the same mat-
ter over which two or more such Secretaries have re-
sponsibility under the provisions of this section (and 
the amendments made thereby) are administered so 
as to have the same effect at all times; and 
(2) coordination of policies relating to enforcing 
the same requirements through such Secretaries in 
order to have a coordinated enforcement strategy 
that avoids duplication of enforcement efforts and 
assigns priorities in enforcement. 
Æ 
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