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General Assembly Substitute Bill No. 838
January Session, 2019
AN ACT CONCERNING RE QUIRED HEALTH INSURA NCE
COVERAGE AND COST -SHARING FOR MAMMOGRAMS 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statutes are repealed and the following is substituted in lieu thereof 2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 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 Substitute Bill No. 838
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breasts if: [a] (i) A mammogram demonstrates heterogeneous or dense 18
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
(c) Benefits under this section shall be subject to any policy 32
provisions that apply to other services covered by such policy, except 33
that no such policy shall impose a coinsurance, copayment, [that 34
exceeds a maximum of twenty dollars for an ultrasound screening 35
under subparagraph (A) of subdivision (2) of subsection (b) of this 36
section] deductible or other out-of-pocket expense for such benefits. 37
The provisions of this subsection shall apply to a high deductible plan, 38
as that term is used in subsection (f) of section 38a-493, to the 39
maximum extent permitted by federal law, except if such plan is used 40
to establish a medical savings account or an Archer MSA pursuant to 41
Section 220 of the Internal Revenue Code of 1986 or any subsequent 42
corresponding internal revenue code of the United States, as amended 43
from time to time, or a health savings account pursuant to Section 223 44
of said Internal Revenue Code, as amended from time to time, the 45
provisions of this subsection shall apply to such plan to the maximum 46
extent that (1) is permitted by federal law, and (2) does not disqualify 47
such account for the deduction allowed under said Section 220 or 223, 48
as applicable. 49
Sec. 2. Subsections (b) and (c) of section 38a-530 of the general 50 Substitute Bill No. 838
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statutes are repealed and the following is substituted in lieu thereof 51
(Effective January 1, 2020): 52
(b) (1) Each group health insurance policy providing coverage of the 53
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-54
469 delivered, issued for delivery, renewed, amended or continued in 55
this state shall provide benefits for mammograms to any woman 56
covered under the policy that are at least equal to the following 57
minimum requirements: (A) A baseline mammogram, which may be 58
provided by breast tomosynthesis at the option of the woman covered 59
under the policy, for any woman who is thirty-five to thirty-nine years 60
of age, inclusive; and (B) a mammogram, which may be provided by 61
breast tomosynthesis at the option of the woman covered under the 62
policy, every year for any woman who is forty years of age or older. 63
(2) Such policy shall provide additional benefits for: 64
(A) Comprehensive ultrasound screening of an entire breast or 65
breasts if: [a] (i) A mammogram demonstrates heterogeneous or dense 66
breast tissue based on the Breast Imaging Reporting and Data System 67
established by the American College of Radiology; [or if] (ii) a woman 68
is believed to be at increased risk for breast cancer due to (I) family 69
history or prior personal history of breast cancer, (II) positive genetic 70
testing, or (III) other indications as determined by a woman's physician 71
or advanced practice registered nurse; or (iii) such screening is 72
recommended by a woman's treating physician for a woman who (I) is 73
forty years of age or older, (II) has a family history or prior personal 74
history of breast cancer, or (III) has a prior personal history of breast 75
disease diagnosed through biopsy as benign; and 76
(B) Magnetic resonance imaging of an entire breast or breasts in 77
accordance with guidelines established by the American Cancer 78
Society. 79
(c) Benefits under this section shall be subject to any policy 80
provisions that apply to other services covered by such policy, except 81 Substitute Bill No. 838
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that no such policy shall impose a coinsurance, copayment, [that 82
exceeds a maximum of twenty dollars for an ultrasound screening 83
under subparagraph (A) of subdivision (2) of subsection (b) of this 84
section] deductible or other out-of-pocket expense for such benefits. 85
The provisions of this subsection shall apply to a high deductible plan, 86
as that term is used in subsection (f) of section 38a-520, to the 87
maximum extent permitted by federal law, except if such plan is used 88
to establish a medical savings account or an Archer MSA pursuant to 89
Section 220 of the Internal Revenue Code of 1986 or any subsequent 90
corresponding internal revenue code of the United States, as amended 91
from time to time, or a health savings account pursuant to Section 223 92
of said Internal Revenue Code, as amended from time to time, the 93
provisions of this subsection shall apply to such plan to the maximum 94
extent that (1) is permitted by federal law, and (2) does not disqualify 95
such account for the deduction allowed under said Section 220 or 223, 96
as applicable. 97
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)
INS Joint Favorable Subst.