Arizona 2025 Regular Session

Arizona House Bill HB2561 Compare Versions

Only one version of the bill is available at this time.

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1	1	REFERENCE TITLE: insurance; cost sharing; breast examinations State of Arizona House of Representatives Fifty-seventh Legislature First Regular Session 2025 HB 2561 Introduced by Representative Pea AN ACT amending title 20, chapter 4, article 3, Arizona Revised Statutes, by adding section 20-841.14; amending title 20, chapter 4, article 9, Arizona Revised Statutes, by adding section 20-1057.20; amending title 20, chapter 6, article 4, Arizona Revised Statutes, by adding section 20-1376.11; amending title 20, chapter 6, article 5, Arizona Revised Statutes, by adding section 20-1406.11; relating to health insurance. (TEXT OF BILL BEGINS ON NEXT PAGE)
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9	9	REFERENCE TITLE: insurance; cost sharing; breast examinations
10	10	State of Arizona House of Representatives Fifty-seventh Legislature First Regular Session 2025
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14	14	REFERENCE TITLE: insurance; cost sharing; breast examinations
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40	40	HB 2561
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44	44	Introduced by
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64	64	AN ACT
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68	68	amending title 20, chapter 4, article 3, Arizona Revised Statutes, by adding section 20-841.14; amending title 20, chapter 4, article 9, Arizona Revised Statutes, by adding section 20-1057.20; amending title 20, chapter 6, article 4, Arizona Revised Statutes, by adding section 20-1376.11; amending title 20, chapter 6, article 5, Arizona Revised Statutes, by adding section 20-1406.11; relating to health insurance.
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78	78	Be it enacted by the Legislature of the State of Arizona: Section 1. Title 20, chapter 4, article 3, Arizona Revised Statutes, is amended by adding section 20-841.14, to read: START_STATUTE20-841.14. Breast examinations; cost sharing; exception; definitions A. a hospital service corporation or medical service corporation that issues, amends, delivers or renews a subscription contract On or after January 1, 2026 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations. B. For the purposes of this section: 1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense. 2. "Diagnostic Breast Examination": (a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines. (b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either: (i) Seen or suspected from a screening examination for breast cancer. (ii) Detected by another means of examination. 3. "Supplemental breast examination": (a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines. (b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following: (i) Used to screen for breast cancer when there is no abnormality seen or suspected. (ii) Based on a personal or family medical history. (iii) Based on additional factors that may increase an individual's risk of breast cancer. END_STATUTE Sec. 2. Title 20, chapter 4, article 9, Arizona Revised Statutes, is amended by adding section 20-1057.20, to read: START_STATUTE20-1057.20. Breast examinations; cost sharing; exception; definitions A. a health care services organization that issues, amends, delivers or renews an evidence of coverage On or after January 1, 2026 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations. B. For the purposes of this section: 1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense. 2. "Diagnostic Breast Examination": (a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines. (b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either: (i) Seen or suspected from a screening examination for breast cancer. (ii) Detected by another means of examination. 3. "Supplemental breast examination": (a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines. (b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following: (i) Used to screen for breast cancer when there is no abnormality seen or suspected. (ii) Based on a personal or family medical history. (iii) Based on additional factors that may increase an individual's risk of breast cancer. END_STATUTE Sec. 3. Title 20, chapter 6, article 4, Arizona Revised Statutes, is amended by adding section 20-1376.11, to read: START_STATUTE20-1376.11. Breast examinations; cost sharing; exception; definitions A. a disability insurer that issues, amends, delivers or renews a policy On or after January 1, 2026 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations. B. For the purposes of this section: 1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense. 2. "Diagnostic Breast Examination": (a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines. (b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either: (i) Seen or suspected from a screening examination for breast cancer. (ii) Detected by another means of examination. 3. "Supplemental breast examination": (a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines. (b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following: (i) Used to screen for breast cancer when there is no abnormality seen or suspected. (ii) Based on a personal or family medical history. (iii) Based on additional factors that may increase an individual's risk of breast cancer. END_STATUTE Sec. 4. Title 20, chapter 6, article 5, Arizona Revised Statutes, is amended by adding section 20-1406.11, to read: START_STATUTE20-1406.11. Breast examinations; cost sharing; exception; definitions A. a group or blanket disability insurer that issues, amends, delivers or renews a policy On or after January 1, 2026 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations. B. For the purposes of this section: 1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense. 2. "Diagnostic Breast Examination": (a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines. (b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either: (i) Seen or suspected from a screening examination for breast cancer. (ii) Detected by another means of examination. 3. "Supplemental breast examination": (a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines. (b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following: (i) Used to screen for breast cancer when there is no abnormality seen or suspected. (ii) Based on a personal or family medical history. (iii) Based on additional factors that may increase an individual's risk of breast cancer. END_STATUTE
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80	80	Be it enacted by the Legislature of the State of Arizona:
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82	82	Section 1. Title 20, chapter 4, article 3, Arizona Revised Statutes, is amended by adding section 20-841.14, to read:
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84	84	START_STATUTE20-841.14. Breast examinations; cost sharing; exception; definitions
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86	86	A. a hospital service corporation or medical service corporation that issues, amends, delivers or renews a subscription contract On or after January 1, 2026 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations.
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88	88	B. For the purposes of this section:
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90	90	1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense.
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92	92	2. "Diagnostic Breast Examination":
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94	94	(a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines.
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96	96	(b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either:
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98	98	(i) Seen or suspected from a screening examination for breast cancer.
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100	100	(ii) Detected by another means of examination.
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102	102	3. "Supplemental breast examination":
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104	104	(a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines.
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106	106	(b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following:
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108	108	(i) Used to screen for breast cancer when there is no abnormality seen or suspected.
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110	110	(ii) Based on a personal or family medical history.
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112	112	(iii) Based on additional factors that may increase an individual's risk of breast cancer. END_STATUTE
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114	114	Sec. 2. Title 20, chapter 4, article 9, Arizona Revised Statutes, is amended by adding section 20-1057.20, to read:
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116	116	START_STATUTE20-1057.20. Breast examinations; cost sharing; exception; definitions
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118	118	A. a health care services organization that issues, amends, delivers or renews an evidence of coverage On or after January 1, 2026 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations.
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120	120	B. For the purposes of this section:
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122	122	1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense.
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124	124	2. "Diagnostic Breast Examination":
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126	126	(a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines.
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128	128	(b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either:
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130	130	(i) Seen or suspected from a screening examination for breast cancer.
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132	132	(ii) Detected by another means of examination.
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134	134	3. "Supplemental breast examination":
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136	136	(a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines.
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138	138	(b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following:
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140	140	(i) Used to screen for breast cancer when there is no abnormality seen or suspected.
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142	142	(ii) Based on a personal or family medical history.
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144	144	(iii) Based on additional factors that may increase an individual's risk of breast cancer. END_STATUTE
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146	146	Sec. 3. Title 20, chapter 6, article 4, Arizona Revised Statutes, is amended by adding section 20-1376.11, to read:
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148	148	START_STATUTE20-1376.11. Breast examinations; cost sharing; exception; definitions
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150	150	A. a disability insurer that issues, amends, delivers or renews a policy On or after January 1, 2026 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations.
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152	152	B. For the purposes of this section:
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154	154	1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense.
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156	156	2. "Diagnostic Breast Examination":
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158	158	(a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines.
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160	160	(b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either:
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162	162	(i) Seen or suspected from a screening examination for breast cancer.
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164	164	(ii) Detected by another means of examination.
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166	166	3. "Supplemental breast examination":
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168	168	(a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines.
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170	170	(b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following:
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172	172	(i) Used to screen for breast cancer when there is no abnormality seen or suspected.
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174	174	(ii) Based on a personal or family medical history.
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176	176	(iii) Based on additional factors that may increase an individual's risk of breast cancer. END_STATUTE
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178	178	Sec. 4. Title 20, chapter 6, article 5, Arizona Revised Statutes, is amended by adding section 20-1406.11, to read:
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180	180	START_STATUTE20-1406.11. Breast examinations; cost sharing; exception; definitions
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182	182	A. a group or blanket disability insurer that issues, amends, delivers or renews a policy On or after January 1, 2026 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations.
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184	184	B. For the purposes of this section:
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186	186	1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense.
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188	188	2. "Diagnostic Breast Examination":
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190	190	(a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines.
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192	192	(b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either:
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194	194	(i) Seen or suspected from a screening examination for breast cancer.
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196	196	(ii) Detected by another means of examination.
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198	198	3. "Supplemental breast examination":
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200	200	(a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines.
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202	202	(b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following:
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204	204	(i) Used to screen for breast cancer when there is no abnormality seen or suspected.
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206	206	(ii) Based on a personal or family medical history.
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208	208	(iii) Based on additional factors that may increase an individual's risk of breast cancer. END_STATUTE