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SF 5217

Health plans requirement to provide coverage for cancer screenings pursuant to American Cancer Society guidelines

2025-2026 Regular Session Introduced by Liz Boldon and 1 co-sponsor

Requires health plans to cover routine cancer screenings (ACS guidelines) with no cost-sharing. Applies to breast, cervical, colorectal, prostate, ovarian, lung testing. January 20

Author added Boldon
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Bill Summary · SF 5217

Summary of Bill SF 5217 (2025-2026) – Minnesota

Purpose and Intent

  • Mandates health plans to provide coverage for cancer screenings in alignment with the current American Cancer Society (ACS) guidelines.
  • Aims to ensure routine, guideline-based cancer screening is covered with no cost-sharing, improving access and affordability for Minnesota residents.

Key Provisions

Section 1: Health plan coverage for routine cancer screenings (Minnesota Statutes 62A.30, subd. 2)

  • Mandatory coverage for routine cancer screening procedures for Minnesota residents, including:
    • Mammograms
    • Surveillance tests for ovarian cancer for women at-risk
    • Pap smears
    • Colorectal cancer screening (men and women)
    • Office or facility visits associated with screening
  • Coverage must follow the standard medical practice and current ACS guidelines.
  • Specific ACS-guideline-based requirements:
    • Colorectal cancer: Coverage consistent with ACS guidelines; includes all examinations and tests identified by ACS screening guidelines, and follow-up colonoscopy after a positive noninvasive test.
    • Breast cancer: Coverage for all breast cancer screening examinations and tests at frequencies identified by ACS guidelines for average-risk and high-risk individuals, including all breast exams required by related subdivisions.
  • Cost-sharing prohibition:
    • Health plans may not impose deductibles, co-pays, or coinsurance for these covered screenings.

Section 2: Prostate cancer screening (Minnesota Statutes 62Q.50)

  • Mandatory coverage for prostate cancer screening:
    • For men aged 40+ who are symptomatic or high-risk, and for men aged 50+ generally, in line with ACS guidelines.
    • Minimum coverage includes a PSA blood test and a digital rectal examination.
    • Coverage extends to all EPS/ACS-identified screening tests and follow-up examinations (e.g., urinary analysis, biomarkers, imaging, biopsy).
  • Cost-sharing prohibition:
    • No co-pays, deductibles, or coinsurance for this coverage.
  • Broad definition:
    • “Health plan” includes coverage that might be excluded under other parts of statute (ensuring broad applicability).

Section 3: Cervical cancer screening (Minnesota Statutes 62Q.501)

  • Health plans must cover cervical cancer screening for women consistent with ACS guidelines.
  • Coverage includes all cervical screening examinations and tests identified by ACS guidelines, and follow-up exams to evaluate abnormalities (even if different samples or dates are involved).
  • Follow-up exams can include HPV typing, cytology, dual-stain testing, colposcopy with biopsy, etc.
  • Cost-sharing prohibition:
    • No co-pays, deductibles, or coinsurance for this coverage.

Section 4: Lung cancer screening (Minnesota Statutes 62Q.502)

  • Health plans must cover lung cancer screening consistent with ACS guidelines.
  • Coverage includes all lung cancer screening tests and associated follow-up examinations (e.g., chest imaging, MRI, CT, PET, biopsy).
  • Cost-sharing prohibition:
    • No co-pays, deductibles, or coinsurance for this coverage.

Section 5: Effective date

  • Sections 1–4 become effective January 1, 2027.
  • Applies to health plans offered, issued, or renewed on or after that date.

Who Would Be Affected

  • Health plans offered in Minnesota (insurers, employer-based plans, and possibly self-funded plans depending on the plan language).
  • Minnesota residents eligible for routine cancer screenings (mammography, colorectal, breast, ovarian, cervical, prostate, and lung cancer screening) as per ACS guidelines.
  • Providers who order screenings would rely on ACS-guideline-based coverage parameters.

Timeline and Procedural Aspects

  • Introduced and referred to the Commerce and Consumer Protection committee on April 27, 2026.
  • Effective implementation date set for plan years beginning on or after January 1, 2027.

Impact Considerations

  • Access and affordability: By prohibiting cost-sharing for guideline-based screenings, the bill lowers out-of-pocket costs for preventive cancer screening.
  • Alignment with ACS guidelines: Ensures Minnesota’s coverage mirrors current best-practice recommendations, potentially reducing late-stage cancer diagnoses.
  • Implementation: Plans would need to update coverage policies to reflect ACS guidelines and ensure no-cost-sharing for the specified screenings starting in 2027.

Compiled from official sources — confirm details with the bill’s official record.

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