LCO No. 4030 1 of 5
General Assembly Raised Bill No. 838
January Session, 2019
LCO No. 4030
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING RE QUIRED HEALTH INSURANCE
COVERAGE AND COST -SHARING FOR MAMMOGRA MS AND
BREAST ULTRASOUNDS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Subsections (b) and (c) of section 38a-503 of the general 1
statutes are repealed and the following is substituted in lieu thereof 2
(Effective 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 Raised Bill No. 838
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under the policy, every year for any woman who (i) is [forty] thirty 15
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
(c) Benefits under this section shall be subject to any policy 35
provisions that apply to other services covered by such policy, except 36
that no such policy shall impose a coinsurance, copayment, [that 37
exceeds a maximum of twenty dollars for an ultrasound screening 38
under subparagraph (A) of subdivision (2) of subsection (b) of this 39
section] deductible or other out-of-pocket expense for such benefits. 40
The provisions of this subsection shall apply to a high deductible plan, 41
as that term is used in subsection (f) of section 38a-493, to the 42
maximum extent permitted by federal law, except if such plan is used 43
to establish a health savings account, as that term is used in Section 223 44
of the Internal Revenue Code of 1986 or any subsequent corresponding 45
internal revenue code of the United States, as amended from time to 46 Raised Bill No. 838
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time, the provisions of this subsection shall apply to such plan to the 47
maximum extent that (1) is permitted by federal law, and (2) does not 48
disqualify such account for the deduction allowed under said Section 49
223. 50
Sec. 2. Subsections (b) and (c) of section 38a-530 of the general 51
statutes are repealed and the following is substituted in lieu thereof 52
(Effective January 1, 2020): 53
(b) (1) Each group health insurance policy providing coverage of the 54
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-55
469 delivered, issued for delivery, renewed, amended or continued in 56
this state shall provide benefits for mammograms to any woman 57
covered under the policy that are at least equal to the following 58
minimum requirements: (A) A baseline mammogram, which may be 59
provided by breast tomosynthesis at the option of the woman covered 60
under the policy, for any woman who is [thirty-five to thirty-nine] 61
thirty years of age [, inclusive] or older; and (B) if recommended by 62
such woman's treating physician, a mammogram, which may be 63
provided by breast tomosynthesis at the option of the woman covered 64
under the policy, every year for any woman who (i) is [forty] thirty 65
years of age or older, (ii) has a family history or prior personal history 66
of breast cancer, or (iii) has a prior personal history of breast disease 67
diagnosed through biopsy as benign. 68
(2) Such policy shall provide additional benefits for: 69
(A) Comprehensive ultrasound screening of an entire breast or 70
breasts if: [a] (i) A mammogram demonstrates heterogeneous or dense 71
breast tissue based on the Breast Imaging Reporting and Data System 72
established by the American College of Radiology; [or if] (ii) a woman 73
is believed to be at increased risk for breast cancer due to (I) family 74
history or prior personal history of breast cancer, (II) positive genetic 75
testing, or (III) other indications as determined by a woman's physician 76
or advanced practice registered nurse; or (iii) such screening is 77
recommended by a woman's treating physician for a woman who (I) is 78 Raised Bill No. 838
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thirty years of age or older, (II) has a family history or prior personal 79
history of breast cancer, or (III) has a prior personal history of breast 80
disease diagnosed through biopsy as benign; and 81
(B) Magnetic resonance imaging of an entire breast or breasts in 82
accordance with guidelines established by the American Cancer 83
Society. 84
(c) Benefits under this section shall be subject to any policy 85
provisions that apply to other services covered by such policy, except 86
that no such policy shall impose a coinsurance, copayment, [that 87
exceeds a maximum of twenty dollars for an ultrasound screening 88
under subparagraph (A) of subdivision (2) of subsection (b) of this 89
section] deductible or other out-of-pocket expense for such benefits. 90
The provisions of this subsection shall apply to a high deductible plan, 91
as that term is used in subsection (f) of section 38a-493, to the 92
maximum extent permitted by federal law, except if such plan is used 93
to establish a health savings account, as that term is used in Section 223 94
of the Internal Revenue Code of 1986 or any subsequent corresponding 95
internal revenue code of the United States, as amended from time to 96
time, the provisions of this subsection shall apply to such plan to the 97
maximum extent that (1) is permitted by federal law, and (2) does not 98
disqualify such account for the deduction allowed under said Section 99
223. 100
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2020 38a-503(b) and (c)
Sec. 2 January 1, 2020 38a-530(b) and (c)
Statement of Purpose:
To (1) eliminate cost-sharing for certain mammograms and breast
ultrasounds, and (2) require health insurance coverage for (A) a
baseline mammogram for any woman who is thirty years of age or
older, (B) an annual mammogram for any woman who receives a
recommendation from such woman's treating physician and (i) is Raised Bill No. 838
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thirty years of age or older, (ii) has a family history or prior personal
history of breast cancer, or (iii) has a prior personal history of breast
disease diagnosed through biopsy as benign, and (C) comprehensive
breast ultrasound screening for any woman who receives a
recommendation from such woman's treating physician and (i) is
thirty years of age or older, (ii) has a family history or prior personal
history of breast cancer, or (iii) 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.]