LCO No. 4014 1 of 4
General Assembly Raised Bill No. 7124
January Session, 2019
LCO No. 4014
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING RE QUIRED HEALTH INSURANCE
COVERAGE FOR MAMMOGR AMS AND BREAST ULTRA SOUNDS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Subsection (b) of section 38a-503 of the general statutes is 1
repealed and the following is substituted in lieu thereof (Effective 2
January 1, 2020): 3
(b) (1) Each individual health insurance policy providing coverage 4
of the type specified in subdivisions (1), (2), (4), (10), (11) and (12) of 5
section 38a-469 delivered, issued for delivery, renewed, amended or 6
continued in this state shall provide benefits for mammograms to any 7
woman covered under the policy that are at least equal to the 8
following minimum requirements: (A) A baseline mammogram, which 9
may be provided by breast tomosynthesis at the option of the woman 10
covered under the policy, for any woman who is [thirty-five to thirty-11
nine] thirty years of age [, inclusive] or older; and (B) if recommended 12
by such woman's treating physician, a mammogram, which may be 13
provided by breast tomosynthesis at the option of the woman covered 14
under the policy, every year for any woman who (i) is [forty] thirty 15 Raised Bill No. 7124
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years of age or older, (ii) has a family history or prior personal history 16
of breast cancer, or (iii) has a prior personal history of breast disease 17
diagnosed through biopsy as benign. 18
(2) Such policy shall provide additional benefits for: 19
(A) Comprehensive ultrasound screening of an entire breast or 20
breasts if: [a] (i) A mammogram demonstrates heterogeneous or dense 21
breast tissue based on the Breast Imaging Reporting and Data System 22
established by the American College of Radiology; [or if] (ii) a woman 23
is believed to be at increased risk for breast cancer due to (I) family 24
history or prior personal history of breast cancer, (II) positive genetic 25
testing, or (III) other indications as determined by a woman's physician 26
or advanced practice registered nurse; or (iii) such screening is 27
recommended by a woman's treating physician for a woman who (I) is 28
thirty years of age or older, (II) has a family history or prior personal 29
history of breast cancer, or (III) has a prior personal history of breast 30
disease diagnosed through biopsy as benign; and 31
(B) Magnetic resonance imaging of an entire breast or breasts in 32
accordance with guidelines established by the American Cancer 33
Society. 34
Sec. 2. Subsection (b) of section 38a-530 of the general statutes is 35
repealed and the following is substituted in lieu thereof (Effective 36
January 1, 2020): 37
(b) (1) Each group health insurance policy providing coverage of the 38
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-39
469 delivered, issued for delivery, renewed, amended or continued in 40
this state shall provide benefits for mammograms to any woman 41
covered under the policy that are at least equal to the following 42
minimum requirements: (A) A baseline mammogram, which may be 43
provided by breast tomosynthesis at the option of the woman covered 44
under the policy, for any woman who is [thirty-five to thirty-nine] 45
thirty years of age [, inclusive] or older; and (B) if recommended by 46
such woman's treating physician, a mammogram, which may be 47 Raised Bill No. 7124
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provided by breast tomosynthesis at the option of the woman covered 48
under the policy, every year for any woman who (i) is [forty] thirty 49
years of age or older, (ii) has a family history or prior personal history 50
of breast cancer, or (iii) has a prior personal history of breast disease 51
diagnosed through biopsy as benign. 52
(2) Such policy shall provide additional benefits for: 53
(A) Comprehensive ultrasound screening of an entire breast or 54
breasts if: [a] (i) A mammogram demonstrates heterogeneous or dense 55
breast tissue based on the Breast Imaging Reporting and Data System 56
established by the American College of Radiology; [or if] (ii) a woman 57
is believed to be at increased risk for breast cancer due to (I) family 58
history or prior personal history of breast cancer, (II) positive genetic 59
testing, or (III) other indications as determined by a woman's physician 60
or advanced practice registered nurse; or (iii) such screening is 61
recommended by a woman's treating physician for a woman who (I) is 62
thirty years of age or older, (II) has a family history or prior personal 63
history of breast cancer, or (III) has a prior personal history of breast 64
disease diagnosed through biopsy as benign; and 65
(B) Magnetic resonance imaging of an entire breast or breasts in 66
accordance with guidelines established by the American Cancer 67
Society. 68
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2020 38a-503(b)
Sec. 2 January 1, 2020 38a-530(b)
Statement of Purpose:
To require health insurance coverage for (1) a baseline mammogram
for any woman who is thirty years of age or older, (2) an annual
mammogram for any woman who receives a recommendation from
such woman's treating physician and (A) is thirty years of age or older,
(B) has a family history or prior personal history of breast cancer, or
(C) has a prior personal history of breast disease diagnosed through Raised Bill No. 7124
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biopsy as benign, and (3) comprehensive breast ultrasound screening
for any woman who receives a recommendation from such woman's
treating physician and (A) is thirty years of age or older, (B) has a
family history or prior personal history of breast cancer, or (C) has a
prior personal history of breast disease diagnosed through biopsy as
benign.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline,
except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is
not underlined.]