Rhode Island 2025 Regular Session

Rhode Island Senate Bill S0197 Compare Versions

Only one version of the bill is available at this time.

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5	5	2025 -- S 0197
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7	7	LC000126
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9	9	S T A T E O F R H O D E I S L A N D
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2025
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
16	16	Introduced By: Senators Zurier, Ujifusa, Lauria, Sosnowski, Gallo, Lawson, and Tikoian
17	17	Date Introduced: February 07, 2025
18	18	Referred To: Senate Health & Human Services
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20	20
21	21	It is enacted by the General Assembly as follows:
22	22	SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance 1
23	23	Policies" is hereby amended by adding thereto the following section: 2
24	24	27-18-42.1. Diagnostic and supplemental breast examination. 3
25	25	(a) As used in this section, the following words shall have the following meanings: 4
26	26	(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any 5
27	27	maximum limitation on the application of such a deductible, coinsurance, copayment or similar 6
28	28	out-of-pocket expense. 7
29	29	(2) "Diagnostic breast examinations" means a medically necessary and appropriate 8
30	30	examination of the breast, including an examination using diagnostic mammography, breast 9
31	31	magnetic resonance imaging, or breast ultrasound, that is: 10
32	32	(i) Used to evaluate an abnormality seen or suspected from a screening examination for 11
33	33	breast cancer; or 12
34	34	(ii) Used to evaluate an abnormality detected by another means of examination. 13
35	35	(3) "Supplemental breast examinations" means a medically necessary and appropriate 14
36	36	examination of the breast, including an examination using breast magnetic resonance imaging, or 15
37	37	breast ultrasound, that is: 16
38	38	(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and 17
39	39	(ii) Based on personal or family medical history, or additional factors that may increase the 18
40	40	individual’s risk of breast cancer. 19
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43	43	LC000126 - Page 2 of 5
44	44	(b) In the case that a group health plan, or a health insurance issuer offering group or 1
45	45	individual health insurance coverage, that provides benefits with respect to screening, supplemental 2
46	46	and diagnostic breast examinations furnished to an individual enrolled under such plan or such 3
47	47	coverage, the plan or coverage shall not impose any cost-sharing requirements. 4
48	48	SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service 5
49	49	Corporations" is hereby amended by adding thereto the following section: 6
50	50	27-19-34.2. Diagnostic and supplemental breast examination. 7
51	51	(a) As used in this section, the following words shall have the following meanings: 8
52	52	(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any 9
53	53	maximum limitation on the application of such a deductible, coinsurance, copayment or similar 10
54	54	out-of-pocket expense. 11
55	55	(2) "Diagnostic breast examinations" means a medically necessary and appropriate 12
56	56	examination of the breast, including an examination using diagnostic mammography, breast 13
57	57	magnetic resonance imaging, or breast ultrasound, that is: 14
58	58	(i) Used to evaluate an abnormality seen or suspected from a screening examination for 15
59	59	breast cancer; or 16
60	60	(ii) Used to evaluate an abnormality detected by another means of examination. 17
61	61	(3) "Supplemental breast examinations" means a medically necessary and appropriate 18
62	62	examination of the breast, including an examination using breast magnetic resonance imaging, or 19
63	63	breast ultrasound, that is: 20
64	64	(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and 21
65	65	(ii) Based on personal or family medical history, or additional factors that may increase the 22
66	66	individual’s risk of breast cancer. 23
67	67	(b) In the case that a group health plan, or a health insurance issuer offering group or 24
68	68	individual health insurance coverage, that provides benefits with respect to screening, supplemental 25
69	69	and diagnostic breast examinations furnished to an individual enrolled under such plan or such 26
70	70	coverage, the plan or coverage shall not impose any cost-sharing requirements. 27
71	71	SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service 28
72	72	Corporations" is hereby amended by adding thereto the following section: 29
73	73	27-20-17.2. Diagnostic and supplemental breast examination. 30
74	74	(a) As used in this section, the following words shall have the following meanings: 31
75	75	(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any 32
76	76	maximum limitation on the application of such a deductible, coinsurance, copayment or similar 33
77	77	out-of-pocket expense. 34
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81	81	(2) "Diagnostic breast examinations" means a medically necessary and appropriate 1
82	82	examination of the breast, including an examination using diagnostic mammography, breast 2
83	83	magnetic resonance imaging, or breast ultrasound, that is: 3
84	84	(i) Used to evaluate an abnormality seen or suspected from a screening examination for 4
85	85	breast cancer; or 5
86	86	(ii) Used to evaluate an abnormality detected by another means of examination. 6
87	87	(3) "Supplemental breast examinations" means a medically necessary and appropriate 7
88	88	examination of the breast, including an examination using breast magnetic resonance imaging, or 8
89	89	breast ultrasound, that is: 9
90	90	(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and 10
91	91	(ii) Based on personal or family medical history, or additional factors that may increase the 11
92	92	individual’s risk of breast cancer. 12
93	93	(b) In the case that a group health plan, or a health insurance issuer offering group or 13
94	94	individual health insurance coverage, that provides benefits with respect to screening, supplemental 14
95	95	and diagnostic breast examinations furnished to an individual enrolled under such plan or such 15
96	96	coverage, the plan or coverage shall not impose any cost-sharing requirements. 16
97	97	SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance 17
98	98	Organizations" is hereby amended by adding thereto the following section: 18
99	99	27-41-30.2. Diagnostic and supplemental breast examination. 19
100	100	(a) As used in this section, the following words shall have the following meanings: 20
101	101	(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any 21
102	102	maximum limitation on the application of such a deductible, coinsurance, copayment or similar 22
103	103	out-of-pocket expense. 23
104	104	(2) "Diagnostic breast examinations" means a medically necessary and appropriate 24
105	105	examination of the breast, including an examination using diagnostic mammography, breast 25
106	106	magnetic resonance imaging, or breast ultrasound, that is: 26
107	107	(i) Used to evaluate an abnormality seen or suspected from a screening examination for 27
108	108	breast cancer; or 28
109	109	(ii) Used to evaluate an abnormality detected by another means of examination. 29
110	110	(3) "Supplemental breast examinations" means a medically necessary and appropriate 30
111	111	examination of the breast, including an examination using breast magnetic resonance imaging, or 31
112	112	breast ultrasound, that is: 32
113	113	(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and 33
114	114	(ii) Based on personal or family medical history, or additional factors that may increase the 34
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117	117	LC000126 - Page 4 of 5
118	118	individual’s risk of breast cancer. 1
119	119	(b) In the case that a group health plan, or a health insurance issuer offering group or 2
120	120	individual health insurance coverage, that provides benefits with respect to screening, supplemental 3
121	121	and diagnostic breast examinations furnished to an individual enrolled under such plan or such 4
122	122	coverage, the plan or coverage shall not impose any cost-sharing requirements. 5
123	123	SECTION 5. This act shall take effect on January 1, 2026. 6
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130	130	EXPLANATION
131	131	BY THE LEGISLATIVE COUNCIL
132	132	OF
133	133	A N A C T
134	134	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
135	135	***
136	136	This act would prohibit an insurance company from imposing any cost-sharing 1
137	137	requirements for any diagnostic or supplemental breast examinations. 2
138	138	This act would take effect on January 1, 2026. 3
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140	140	LC000126
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