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General Assembly Substitute Bill No. 7124
January Session, 2019
AN ACT CONCERNING RE QUIRED HEALTH INSURA NCE
COVERAGE FOR MAMMOGR AMS AND BREAST ULTRASOUNDS.
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repealed and the following is substituted in lieu thereof (Effective 2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 years of age, inclusive; and (B) a mammogram, which may be 12
provided by breast tomosynthesis at the option of the woman covered 13
under the policy, every year for any woman who is forty years of age 14
or older. 15
(2) Such policy shall provide additional benefits for: 16
(A) Comprehensive ultrasound screening of an entire breast or 17
breasts if: [a] (i) A mammogram demonstrates heterogeneous or dense 18 Substitute Bill No. 7124
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breast tissue based on the Breast Imaging Reporting and Data System 19
established by the American College of Radiology; [or if] (ii) a woman 20
is believed to be at increased risk for breast cancer due to (I) family 21
history or prior personal history of breast cancer, (II) positive genetic 22
testing, or (III) other indications as determined by a woman's physician 23
or advanced practice registered nurse; or (iii) such screening is 24
recommended by a woman's treating physician for a woman who (I) is 25
forty years of age or older, (II) has a family history or prior personal 26
history of breast cancer, or (III) has a prior personal history of breast 27
disease diagnosed through biopsy as benign; and 28
(B) Magnetic resonance imaging of an entire breast or breasts in 29
accordance with guidelines established by the American Cancer 30
Society. 31
Sec. 2. Subsection (b) of section 38a-530 of the general statutes is 32
repealed and the following is substituted in lieu thereof (Effective 33
January 1, 2020): 34
(b) (1) Each group health insurance policy providing coverage of the 35
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-36
469 delivered, issued for delivery, renewed, amended or continued in 37
this state shall provide benefits for mammograms to any woman 38
covered under the policy that are at least equal to the following 39
minimum requirements: (A) A baseline mammogram, which may be 40
provided by breast tomosynthesis at the option of the woman covered 41
under the policy, for any woman who is thirty-five to thirty-nine years 42
of age, inclusive; and (B) a mammogram, which may be provided by 43
breast tomosynthesis at the option of the woman covered under the 44
policy, every year for any woman who is forty years of age or older. 45
(2) Such policy shall provide additional benefits for: 46
(A) Comprehensive ultrasound screening of an entire breast or 47
breasts if: [a] (i) A mammogram demonstrates heterogeneous or dense 48
breast tissue based on the Breast Imaging Reporting and Data System 49 Substitute Bill No. 7124
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established by the American College of Radiology; [or if] (ii) a woman 50
is believed to be at increased risk for breast cancer due to (I) family 51
history or prior personal history of breast cancer, (II) positive genetic 52
testing, or (III) other indications as determined by a woman's physician 53
or advanced practice registered nurse; or (iii) such screening is 54
recommended by a woman's treating physician for a woman who (I) is 55
forty years of age or older, (II) has a family history or prior personal 56
history of breast cancer, or (III) has a prior personal history of breast 57
disease diagnosed through biopsy as benign; and 58
(B) Magnetic resonance imaging of an entire breast or breasts in 59
accordance with guidelines established by the American Cancer 60
Society. 61
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)
INS Joint Favorable Subst.