HB373: HB373 Insurance; annual prostate cancer screenings for certain men; require major medical coverage

Currently, Georgia law does not require health insurance plans to cover prostate cancer screenings. This bill would add a new section to Georgia's insurance code (O.C.G.A. § 33-24-59.34) requiring health benefit policies, meaning individual or group insurance plans that provide major medical benefits, to cover annual prostate cancer screenings for men at high risk of the disease. The bill defines who counts as high risk: men aged 40 to 49 with a family history of prostate cancer, all men age 50 and older, and any other men a physician determines to be at high risk. Covered screenings must include both a digital rectal exam and a prostate-specific antigen (PSA) blood test. The requirement would apply to insurance policies issued, delivered, or renewed on or after January 1, 2026, and takes effect once signed by the Governor or becomes law without signature.

• Adds a new Georgia insurance code section requiring health benefit policies to cover annual prostate cancer screenings for men at high risk.
• Defines 'men with a family history of prostate cancer' based on a first-degree relative's diagnosis, death, or related genetic risk factors.
• Defines 'men with a high risk for prostate cancer' to include men 40-49 with a family history, all men 50 and older, and others a physician identifies as high risk.
• Requires covered screenings to include both a digital rectal examination and a prostate-specific antigen (PSA) test.
• Applies the coverage mandate to insurance policies issued, delivered, or renewed on or after January 1, 2026.

Men in Georgia who are 50 or older, or aged 40-49 with a family history of prostate cancer, along with health insurers, health maintenance organizations, and other entities that issue major medical policies in the state, since they would be required to cover these screenings.

Men who meet the bill's risk criteria would be guaranteed insurance coverage for prostate cancer screenings, including PSA tests and rectal exams, without facing coverage denials for that specific screening. Insurers would need to update policies issued or renewed after January 1, 2026 to include this benefit.

• Section 1 adds new Code Section 33-24-59.34 to Georgia's insurance law, defining 'health benefit policy' as individual or group plans providing major medical benefits.
• Section 1 defines 'men with a family history of prostate cancer' using specific criteria about a first-degree relative's diagnosis, cancer development, death, related cancer diagnosis, or genetic alteration.
• Section 1 defines 'men with a high risk for prostate cancer' as those 40-49 with a family history, all men 50 and older, and others identified by a physician.
• Section 1(b) requires covered health plans to pay for annual screenings including a digital rectal exam and a PSA test for high-risk men.
• Section 2 sets the effective date as upon the Governor's approval or the bill becoming law without approval, applying to policies issued or renewed on or after January 1, 2026.
• Section 3 repeals any conflicting laws.

1. 2025-03-03Senate Read and Referred (Senate)
2. 2025-02-28House Passed/Adopted By Substitute (House)
3. 2025-02-28House Third Readers (House)
4. 2025-02-26House Committee Favorably Reported By Substitute (House)
5. 2025-02-12House Second Readers (House)
6. 2025-02-11House First Readers (House)
7. 2025-02-10House Hopper (House)

• Lydia Glaize (D, HD-067)Primary sponsor
• Mark Newton (R, HD-127)
• Sharon Cooper (R, HD-045)
• Billy Mitchell (D, HD-088)
• Miriam Paris (D, HD-142)
• Spencer Frye (D, HD-122)

1. PassedHouse voteFebruary 28, 2025

   164 yea, 1 nay (5 not voting, 10 absent)

   Passage: House Vote #120

• health insurance coverage
• prostate cancer screening
• cancer prevention
• insurance mandates
• men's health