Introduced Version
HOUSE BILL No. 1061
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 5-10-8-7.2; IC 27-8-14; IC 27-13-7-15.3.
Synopsis: Coverage for cancer screening. Requires a state employee
health plan to cover supplemental breast examinations. Requires a
policy of accident and sickness insurance and a health maintenance
organization to cover diagnostic breast examinations and supplemental
breast examinations. Provides that the coverage for diagnostic breast
examinations and supplemental breast examinations may not be subject
to any cost sharing requirements.
Effective: July 1, 2025.
Pryor
January 8, 2025, read first time and referred to Committee on Insurance.
2025 IN 1061—LS 6456/DI 154 Introduced
First Regular Session of the 124th General Assembly (2025)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2024 Regular Session of the General Assembly.
HOUSE BILL No. 1061
A BILL FOR AN ACT to amend the Indiana Code concerning
insurance.
Be it enacted by the General Assembly of the State of Indiana:
1 SECTION 1. IC 5-10-8-7.2, AS AMENDED BY P.L.3-2024,
2 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
3 JULY 1, 2025]: Sec. 7.2. (a) As used in this section, "breast cancer
4 diagnostic service" means a procedure intended to aid in the diagnosis
5 of breast cancer. The term includes procedures performed on an
6 inpatient basis and procedures performed on an outpatient basis,
7 including the following:
8 (1) Breast cancer screening mammography.
9 (2) Surgical breast biopsy.
10 (3) Pathologic examination and interpretation.
11 (b) As used in this section, "breast cancer outpatient treatment
12 services" means procedures that are intended to treat cancer of the
13 human breast and that are delivered on an outpatient basis. The term
14 includes the following:
15 (1) Chemotherapy.
16 (2) Hormonal therapy.
17 (3) Radiation therapy.
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1 (4) Surgery.
2 (5) Other outpatient cancer treatment services prescribed by a
3 physician.
4 (6) Medical follow-up services related to the procedures set forth
5 in subdivisions (1) through (5).
6 (c) As used in this section, "breast cancer rehabilitative services"
7 means procedures that are intended to improve the results of or to
8 ameliorate the debilitating consequences of the treatment of breast
9 cancer and that are delivered on an inpatient or outpatient basis. The
10 term includes the following:
11 (1) Physical therapy.
12 (2) Psychological and social support services.
13 (3) Reconstructive plastic surgery, including chest wall
14 reconstruction and aesthetic flat closure (as defined by the
15 National Cancer Institute).
16 (d) As used in this section, "breast cancer screening mammography"
17 means a standard, two (2) view per breast, low-dose radiographic
18 examination of the breasts that is:
19 (1) furnished to an asymptomatic woman; and
20 (2) performed by a mammography services provider using
21 equipment designed by the manufacturer for and dedicated
22 specifically to mammography in order to detect unsuspected
23 breast cancer.
24 The term includes the interpretation of the results of a breast cancer
25 screening mammography by a physician.
26 (e) As used in this section, "cost sharing requirements" means:
27 (1) a deductible;
28 (2) coinsurance;
29 (3) a copayment; and
30 (4) any maximum limitation on the application of a
31 deductible, coinsurance, copayment, or similar out-of-pocket
32 expense.
33 (e) (f) As used in this section, "covered individual" means a female
34 individual who is:
35 (1) covered under a self-insurance program established under
36 section 7(b) of this chapter to provide group health coverage; or
37 (2) entitled to services under a contract with a health maintenance
38 organization (as defined in IC 27-13-1-19) that is entered into or
39 renewed under section 7(c) of this chapter.
40 (f) (g) As used in this section, "mammography services provider"
41 means an individual or facility that:
42 (1) has been accredited by the American College of Radiology;
2025 IN 1061—LS 6456/DI 154 3
1 (2) meets equivalent guidelines established by the Indiana
2 department of health; or
3 (3) is certified by the federal Department of Health and Human
4 Services for participation in the Medicare program (42 U.S.C.
5 1395 et seq.).
6 (h) As used in this section, "supplemental breast examination"
7 means a medically necessary and appropriate examination of the
8 breast, including an examination using breast cancer screening
9 mammography, breast magnetic resonance imaging, or ultrasound
10 services, that is:
11 (1) used to screen for breast cancer when there is no
12 abnormality seen or detected; and
13 (2) based on:
14 (A) personal or family medical history; or
15 (B) additional factors;
16 that may increase the covered individual's risk of breast
17 cancer.
18 (g) (i) As used in this section, "woman at risk" means a woman who
19 meets at least one (1) of the following descriptions:
20 (1) A woman who has a personal history of breast cancer.
21 (2) A woman who has a personal history of breast disease that
22 was proven benign by biopsy.
23 (3) A woman whose mother, sister, or daughter has had breast
24 cancer.
25 (4) A woman who is at least thirty (30) years of age and has not
26 given birth.
27 (h) (j) A self-insurance program established under section 7(b) of
28 this chapter to provide health care coverage must provide covered
29 individuals with coverage for breast cancer diagnostic services, breast
30 cancer outpatient treatment services, and breast cancer rehabilitative
31 services. The coverage must provide reimbursement for breast cancer
32 screening mammography at a level at least as high as:
33 (1) the limitation on payment for screening mammography
34 services established in 42 CFR 405.534(b)(3) according to the
35 Medicare Economic Index at the time the breast cancer screening
36 mammography is performed; or
37 (2) the rate negotiated by a contract provider according to the
38 provisions of the insurance policy;
39 whichever is lower. Except as provided in subsection (o), the costs of
40 the coverage required by this subsection may be paid by the state or by
41 the employee or by a combination of the state and the employee.
42 (i) (k) A contract with a health maintenance organization that is
2025 IN 1061—LS 6456/DI 154 4
1 entered into or renewed under section 7(c) of this chapter must provide
2 covered individuals with breast cancer diagnostic services, breast
3 cancer outpatient treatment services, and breast cancer rehabilitative
4 services.
5 (j) (l) The coverage required by subsection (h) (j) and services
6 required by subsection (i) (k) may not be subject to dollar limits,
7 deductibles, or coinsurance provisions that are less favorable to
8 covered individuals than the dollar limits, deductibles, or coinsurance
9 provisions applying to physical illness generally under the
10 self-insurance program or contract with a health maintenance
11 organization.
12 (k) (m) The coverage for breast cancer diagnostic services required
13 by subsection (h) (j) and the breast cancer diagnostic services required
14 by subsection (i) (k) must include the following:
15 (1) In the case of a covered individual who is at least thirty-five
16 (35) years of age but less than forty (40) years of age, at least one
17 (1) baseline breast cancer screening mammography performed
18 upon the individual before she becomes forty (40) years of age.
19 (2) In the case of a covered individual who is:
20 (A) less than forty (40) years of age; and
21 (B) a woman at risk;
22 at least one (1) breast cancer screening mammography performed
23 upon the covered individual every year.
24 (3) In the case of a covered individual who is at least forty (40)
25 years of age, at least one (1) breast cancer screening
26 mammography performed upon the individual every year.
27 (4) Any additional mammography views that are required for
28 proper evaluation.
29 (5) Ultrasound services, if determined medically necessary by the
30 physician treating the covered individual.
31 (6) Supplemental breast examination.
32 (l) (n) The coverage for breast cancer diagnostic services required
33 by subsection (h) (j) and the breast cancer diagnostic services required
34 by subsection (i) (k) shall be provided in addition to any benefits
35 specifically provided for x-rays, laboratory testing, or wellness
36 examinations.
37 (o) The coverage for breast cancer diagnostic services required
38 by subsection (j) and the breast cancer diagnostic services required
39 by subsection (k) may not be subject to any cost sharing
40 requirements.
41 SECTION 2. IC 27-8-14-2.5 IS ADDED TO THE INDIANA CODE
42 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
2025 IN 1061—LS 6456/DI 154 5
1 1, 2025]: Sec. 2.5. As used in this chapter, "cost sharing
2 requirements" means:
3 (1) a deductible;
4 (2) coinsurance;
5 (3) a copayment; and
6 (4) any maximum limitation on the application of a
7 deductible, coinsurance, copayment, or similar out-of-pocket
8 expense.
9 SECTION 3. IC 27-8-14-2.7 IS ADDED TO THE INDIANA CODE
10 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
11 1, 2025]: Sec. 2.7. As used in this chapter, "diagnostic breast
12 examination" means a medically necessary and appropriate
13 examination of the breast, including an examination using
14 diagnostic mammography, breast magnetic resonance imaging, or
15 ultrasound services, that is:
16 (1) used to evaluate an abnormality seen or suspected from a
17 screening examination for breast cancer; or
18 (2) used to evaluate an abnormality detected by another
19 means of examination.
20 SECTION 4. IC 27-8-14-4.5 IS ADDED TO THE INDIANA CODE
21 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
22 1, 2025]: Sec. 4.5. As used in this chapter, "supplemental breast
23 examination" means a medically necessary and appropriate
24 examination of the breast, including an examination using
25 diagnostic mammography, breast magnetic resonance imaging, or
26 ultrasound services, that is:
27 (1) used to screen for breast cancer when there is no
28 abnormality seen or detected; and
29 (2) based on:
30 (A) personal or family medical history; or
31 (B) additional factors;
32 that may increase the insured's risk of breast cancer.
33 SECTION 5. IC 27-8-14-6 IS AMENDED TO READ AS
34 FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 6. (a) Except as
35 provided in subsection (f), (g), an insurer must provide coverage for
36 breast cancer screening mammography and diagnostic breast
37 examination in any accident and sickness insurance policy that the
38 insurer issues in Indiana.
39 (b) Except as provided in subsection (f), (g), the coverage that an
40 insurer must provide under this section must include the following:
41 (1) If the insured is at least thirty-five (35) but less than forty (40)
42 years of age, coverage for at least one (1) baseline breast cancer
2025 IN 1061—LS 6456/DI 154 6
1 screening mammography performed upon the insured before she
2 becomes forty (40) years of age.
3 (2) If the insured is:
4 (A) less than forty (40) years of age; and
5 (B) a woman at risk;
6 one (1) breast cancer screening mammography performed upon
7 the insured every year.
8 (3) If the insured is at least forty (40) years of age, one (1) breast
9 cancer screening mammography performed upon the insured
10 every year.
11 (4) Any additional mammography views that are required for
12 proper evaluation.
13 (5) Ultrasound services, if determined medically necessary by the
14 physician treating the insured.
15 (6) Supplemental breast examination.
16 (c) Except as provided in subsection (f), (g), the coverage that an
17 insurer must provide under this section must provide reimbursement
18 for breast cancer screening mammography at a level at least as high as:
19 (1) the limitation on payment for screening mammography
20 services established in 42 CFR 405.534(b)(3) according to the
21 Medicare Economic Index at the time the breast cancer screening
22 mammography is performed; or
23 (2) the rate negotiated by a contract provider according to the
24 provisions of the insurance policy;
25 whichever is lower.
26 (d) Except as provided in subsection (f), (g), the coverage that an
27 insurer must provide under this section may not be subject to dollar
28 limits, deductibles, or coinsurance provisions that are less favorable to
29 the insured than the dollar limits, deductibles, or coinsurance
30 provisions applying to physical illness generally under the accident and
31 sickness insurance policy.
32 (e) Except as provided in subsection (f), (g), the coverage that an
33 insurer must provide is in addition to any benefits specifically provided
34 for x-rays, laboratory testing, or wellness examinations.
35 (f) Except as provided in subsection (g), the coverage that an
36 insurer must provide under this section may not be subject to any
37 cost sharing requirements.
38 (f) (g) In the case of insurance policies that are not employer based,
39 the insurer must offer to provide the coverage described in subsections
40 (a) through (e). (f).
41 SECTION 6. IC 27-13-7-15.3 IS AMENDED TO READ AS
42 FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 15.3. (a) As used in this
2025 IN 1061—LS 6456/DI 154 7
1 section, "breast cancer screening mammography" has the meaning set
2 forth in IC 27-8-14-2.
3 (b) As used in this section, "cost sharing requirements" has the
4 meaning set forth in IC 27-8-14-2.5.
5 (c) As used in this section, "diagnostic breast examination" has
6 the meaning set forth in IC 27-8-14-2.7.
7 (d) As used in this section, "supplemental breast examination"
8 has the meaning set forth in IC 27-8-14-4.5.
9 (b) (e) As used in this section, "woman at risk" has the meaning set
10 forth in IC 27-8-14-5.
11 (c) (f) Except as provided in subsection (g), (k), a health
12 maintenance organization issued a certificate of authority in Indiana
13 shall provide breast cancer screening mammography and diagnostic
14 breast examination as a covered service services under every group
15 contract that provides coverage for basic health care services.
16 (d) (g) Except as provided in subsection (g), (k), the coverage that
17 a health maintenance organization must provide under this section must
18 include the following:
19 (1) If the enrollee is at least thirty-five (35) years of age but less
20 than forty (40) years of age and a female, coverage for at least one
21 (1) baseline breast cancer screening mammography performed
22 upon the enrollee before the enrollee becomes forty (40) years of
23 age.
24 (2) If the enrollee is less than forty (40) years of age and a woman
25 at risk, one (1) breast cancer screening mammography performed
26 upon the enrollee every year.
27 (3) If the enrollee is at least forty (40) years of age and a female,
28 one (1) breast cancer screening mammography performed upon
29 the enrollee every year.
30 (4) Any additional mammography views that are required for
31 proper evaluation.
32 (5) Ultrasound services, if determined medically necessary by the
33 physician treating the enrollee.
34 (6) Supplemental breast examination.
35 (e) (h) Except as provided in subsection (g), (k), the coverage that
36 a health maintenance organization must provide under this section may
37 not be subject to a contract provision that is less favorable to an
38 enrollee or a subscriber than contract provisions applying to physical
39 illness generally under the health maintenance organization contract.
40 (f) (i) Except as provided in subsection (g), (k), the coverage that a
41 health maintenance organization must provide under this section is in
42 addition to services specifically provided for x-rays, laboratory testing,
2025 IN 1061—LS 6456/DI 154 8
1 or wellness examinations.
2 (j) Except as provided in subsection (k), the coverage that a
3 health maintenance organization must provide under this section
4 may not be subject to any cost sharing requirements.
5 (g) (k) In the case of coverage that is not employer based, the health
6 maintenance organization must offer to provide the coverage described
7 in subsections (c) (f) through (f). (j).
2025 IN 1061—LS 6456/DI 154