An Act to Update the Requirements for Health Insurance Coverage
Maine Legislature, Session 132, LD 1502
Committee: Health Coverage, Insurance and Financial Services
Sponsors: MOONEN
Amends: 24 MRSA §2325-C, 24-A MRSA §2745-G, 24-A MRSA §2837-H, 24-A MRSA §4244

Legislative Document
No. 1502
H.P. 986
House of Representatives, April 8, 2025
An Act to Update the Requirements for Health Insurance Coverage 
of Prostate Cancer Screening
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative MOONEN of Portland.
Cosponsored by Representatives: BOYER of Cape Elizabeth, FLYNN of Albion, FOLEY of 
Wells, MASTRACCIO of Sanford, MATHIESON of Kittery, Senator: BAILEY of York.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24 MRSA §2325-C, as enacted by PL 1997, c. 754, §1, is amended to read:
§2325-C.  Coverage for prostate cancer screening
1.  Definition.  As used in this section, "services for the early detection of prostate 
cancer" means the following procedures provided to a man for the purpose of early 
detection of prostate cancer:
A.  A digital rectal examination; and
B.  A prostate-specific antigen test.
1-A.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings.
A.  "Nationally recognized clinical practice guideline" means an evidence-based 
clinical practice guideline:
(1)  Developed by an independent organization or medical professional society 
using a transparent methodology and reporting structure and with a conflict of 
interest policy;
(2)  That establishes a standard of care informed by a systematic review of evidence 
and an assessment of the benefits and risks of alternative care options; and
(3)  That includes recommendations intended to optimize patient care.
B.  "Services for the early detection of prostate cancer" means medically viable 
methods for the purpose of early detection and diagnosis of prostate cancer, including 
a digital rectal examination and prostate-specific antigen test and associated laboratory 
services. "Services for the early detection of prostate cancer" includes medically 
necessary follow-up testing as directed by a physician, including, but not limited to, 
urinary analysis; serum biomarker testing; and medical imaging such as magnetic 
resonance imaging.
2.  Required coverage for prostate cancer screening.  All individual and group 
nonprofit hospital and medical services plan contracts must provide coverage for services 
for the early detection of prostate cancer.  The contracts must reimburse for services for the 
early detection of prostate cancer, if recommended by a physician, at least once a year for 
men 50 years of age or older until a man reaches the age of 72 when supported by medical 
and scientific evidence according to the most recently published nationally recognized 
clinical practice guideline.
3.  Application.  The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State on 
or after September 1, 1998.  For purposes of this section, all contracts are deemed to be 
renewed no later than the next yearly anniversary of the contract date.
4.  Cost sharing prohibited.  An individual or group nonprofit hospital and medical 
services plan contract may not impose any deductible, copayment, coinsurance or other 
cost-sharing requirement for the costs of services for the early detection of prostate cancer 
required to be covered under subsection 2. This subsection does not apply to a contract 
offered for use with a health savings account unless the United States Internal Revenue 
Service determines that the requirements in this subsection are permissible in a high 
deductible health plan as defined in the United States Internal Revenue Code of 1986, 
Section 223(c)(2).
Sec. 2.  24-A MRSA §2745-G, as enacted by PL 1997, c. 754, §2 and reallocated 
by RR 1997, c. 2, §51, is amended to read:
§2745-G.  Coverage for prostate cancer screening
1.  Definition.  As used in this section, "services for the early detection of prostate 
cancer" means the following procedures provided to a man for the purpose of early 
detection of prostate cancer:
A.  A digital rectal examination; and
B.  A prostate-specific antigen test.
1-A.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings.
A.  "Nationally recognized clinical practice guideline" means an evidence-based 
clinical practice guideline:
(1)  Developed by an independent organization or medical professional society 
using a transparent methodology and reporting structure and with a conflict of 
interest policy;
(2)  That establishes a standard of care informed by a systematic review of evidence 
and an assessment of the benefits and risks of alternative care options; and
(3)  That includes recommendations intended to optimize patient care.
B.  "Services for the early detection of prostate cancer" means medically viable 
methods for the purpose of early detection and diagnosis of prostate cancer, including 
a digital rectal examination and prostate-specific antigen test and associated laboratory 
services. "Services for the early detection of prostate cancer" includes medically 
necessary follow-up testing as directed by a physician, including, but not limited to, 
urinary analysis; serum biomarker testing; and medical imaging such as magnetic 
resonance imaging.
2.  Required coverage for prostate cancer screening.  All individual insurance 
policies and contracts except accidental injury, specified disease, hospital indemnity, 
Medicare supplement, long-term care and other limited benefit health insurance policies 
and contracts must provide coverage for services for the early detection of prostate cancer.  
The contracts must reimburse for services for the early detection of prostate cancer, if 
recommended by a physician, at least once a year for men 50 years of age or older until a 
man reaches the age of 72 when supported by medical and scientific evidence according to 
the most recently published nationally recognized clinical practice guideline.
3.  Application.  The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State on 
or after September 1, 1998.  For purposes of this section, all contracts are deemed to be 
renewed no later than the next yearly anniversary of the contract date.
4.  Cost sharing prohibited.  An individual insurance policy or contract may not 
impose any deductible, copayment, coinsurance or other cost-sharing requirement for the 
costs of services for the early detection of prostate cancer required to be covered under 
subsection 2. This subsection does not apply to a policy or contract offered for use with a 
health savings account unless the United States Internal Revenue Service determines that 
the requirements in this subsection are permissible in a high deductible health plan as 
defined in the United States Internal Revenue Code of 1986, Section 223(c)(2).
Sec. 3.  24-A MRSA §2837-H, as enacted by PL 1997, c. 754, §3 and reallocated 
by RR 1997, c. 2, §52, is amended to read:
§2837-H.  Coverage for prostate cancer screening
1.  Definition.  As used in this section, "services for the early detection of prostate 
cancer" means the following procedures provided to a man for the purpose of early 
detection of prostate cancer:
A.  A digital rectal examination; and
B.  A prostate-specific antigen test.
1-A.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings.
A.  "Nationally recognized clinical practice guideline" means an evidence-based 
clinical practice guideline:
(1)  Developed by an independent organization or medical professional society 
using a transparent methodology and reporting structure and with a conflict of 
interest policy;
(2)  That establishes a standard of care informed by a systematic review of evidence 
and an assessment of the benefits and risks of alternative care options; and
(3)  That includes recommendations intended to optimize patient care.
B.  "Services for the early detection of prostate cancer" means medically viable 
methods for the purpose of early detection and diagnosis of prostate cancer, including 
a digital rectal examination and prostate-specific antigen test and associated laboratory 
services. "Services for the early detection of prostate cancer" includes medically 
necessary follow-up testing as directed by a physician, including, but not limited to, 
urinary analysis; serum biomarker testing; and medical imaging such as magnetic 
resonance imaging.
2.  Required coverage for prostate cancer screening.  All group insurance policies 
and contracts except accidental injury, specified disease, hospital indemnity, Medicare 
supplement, long-term care and other limited benefit health insurance policies and 
contracts must provide coverage for services for the early detection of prostate cancer.  The 
contracts must reimburse for services for the early detection of prostate cancer, if 
recommended by a physician, at least once a year for men 50 years of age or older until a 
man reaches the age of 72 when supported by medical and scientific evidence according to 
the most recently published nationally recognized clinical practice guideline.
3.  Application.  The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State on 
or after September 1, 1998.  For purposes of this section, all contracts are deemed to be 
renewed no later than the next yearly anniversary of the contract date.
4.  Cost sharing prohibited.  A group insurance policy or contract may not impose 
any deductible, copayment, coinsurance or other cost-sharing requirement for the costs of 
services for the early detection of prostate cancer required to be covered under subsection 
2. This subsection does not apply to a policy or contract offered for use with a health 
savings account unless the United States Internal Revenue Service determines that the 
requirements in this subsection are permissible in a high deductible health plan as defined 
in the United States Internal Revenue Code of 1986, Section 223(c)(2).
Sec. 4.  24-A MRSA §4244, as enacted by PL 1997, c. 754, §4 and reallocated by 
RR 1997, c. 2, §53, is amended to read:
§4244.  Coverage for prostate cancer screening
1.  Definition.  As used in this section, "services for the early detection of prostate 
cancer" means the following procedures provided to a man for the purpose of early 
detection of prostate cancer:
A.  A digital rectal examination; and
B.  A prostate-specific antigen test.
1-A.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings.
A.  "Nationally recognized clinical practice guideline" means an evidence-based 
clinical practice guideline:
(1)  Developed by an independent organization or medical professional society 
using a transparent methodology and reporting structure and with a conflict of 
interest policy;
(2)  That establishes a standard of care informed by a systematic review of evidence 
and an assessment of the benefits and risks of alternative care options; and
(3)  That includes recommendations intended to optimize patient care.
B.  "Services for the early detection of prostate cancer" means medically viable 
methods for the purpose of early detection and diagnosis of prostate cancer, including 
a digital rectal examination and prostate-specific antigen test and associated laboratory 
services. "Services for the early detection of prostate cancer" includes medically 
necessary follow-up testing as directed by a physician, including, but not limited to, 
urinary analysis; serum biomarker testing; and medical imaging such as magnetic 
resonance imaging.
2.  Required coverage for prostate cancer screening.  All health maintenance 
organization individual and group contracts must provide coverage for services for the 
early detection of prostate cancer.  The contracts must reimburse for services for the early 
detection of prostate cancer, if recommended by a physician, at least once a year for men 
years of age or older until a man reaches the age of 72 when supported by medical and 
scientific evidence according to the most recently published nationally recognized clinical 
practice guideline.
3.  Application.  The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State on 
or after September 1, 1998.  For purposes of this section, all contracts are deemed to be 
renewed no later than the next yearly anniversary of the contract date.
4.  Cost sharing prohibited.  An individual or group contract may not impose any 
deductible, copayment, coinsurance or other cost-sharing requirement for the costs of 
services for the early detection of prostate cancer required to be covered under subsection 
2. This subsection does not apply to a contract offered for use with a health savings account 
unless the United States Internal Revenue Service determines that the requirements in this 
subsection are permissible in a high deductible health plan as defined in the United States 
Internal Revenue Code of 1986, Section 223(c)(2).
Sec. 5.  Application. This Act applies to all policies, contracts and certificates 
executed, delivered, issued for delivery, continued or renewed in this State on or after 
January 1, 2026.  For purposes of this Act, all contracts are deemed to be renewed no later 
than the next yearly anniversary of the contract date.
SUMMARY
Under current law, health insurance coverage must be provided for annual prostate 
cancer screening, if recommended by a physician, to men 50 years of age or older until 
attaining 72 years of age. This bill updates the required coverage by doing the following. 
1.  It expands the scope of the required screening services to include medically 
necessary follow-up testing as directed by a physician, including, but not limited to, urinary 
analysis; serum biomarker testing; and medical imaging. It retains the provision in current 
law that requires coverage of a digital rectal examination and a prostate-specific antigen 
test and provides that associated laboratory fees for those tests are also covered. 
2.  It requires the coverage of services for the early detection of prostate cancer, if 
recommended by a physician, when supported by medical and scientific evidence 
according to the most recently published nationally recognized clinical practice guideline. 
3.  It prohibits the use of any deductible, copayment, coinsurance or other cost-sharing 
requirement for the costs of services for the early detection of prostate cancer. 
The requirements of the bill apply to health plans issued or renewed on or after January 
1, 2026.