2025 -- S 0197
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LC000126
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S T A T E O F R H O D E I S L A N D
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2025
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A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
Introduced By: Senators Zurier, Ujifusa, Lauria, Sosnowski, Gallo, Lawson, and Tikoian
Date Introduced: February 07, 2025
Referred To: Senate Health & Human Services
It is enacted by the General Assembly as follows:
SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance 1
Policies" is hereby amended by adding thereto the following section: 2
27-18-42.1. Diagnostic and supplemental breast examination. 3
(a) As used in this section, the following words shall have the following meanings: 4
(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any 5
maximum limitation on the application of such a deductible, coinsurance, copayment or similar 6
out-of-pocket expense. 7
(2) "Diagnostic breast examinations" means a medically necessary and appropriate 8
examination of the breast, including an examination using diagnostic mammography, breast 9
magnetic resonance imaging, or breast ultrasound, that is: 10
(i) Used to evaluate an abnormality seen or suspected from a screening examination for 11
breast cancer; or 12
(ii) Used to evaluate an abnormality detected by another means of examination. 13
(3) "Supplemental breast examinations" means a medically necessary and appropriate 14
examination of the breast, including an examination using breast magnetic resonance imaging, or 15
breast ultrasound, that is: 16
(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and 17
(ii) Based on personal or family medical history, or additional factors that may increase the 18
individual’s risk of breast cancer. 19
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(b) In the case that a group health plan, or a health insurance issuer offering group or 1
individual health insurance coverage, that provides benefits with respect to screening, supplemental 2
and diagnostic breast examinations furnished to an individual enrolled under such plan or such 3
coverage, the plan or coverage shall not impose any cost-sharing requirements. 4
SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service 5
Corporations" is hereby amended by adding thereto the following section: 6
27-19-34.2. Diagnostic and supplemental breast examination. 7
(a) As used in this section, the following words shall have the following meanings: 8
(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any 9
maximum limitation on the application of such a deductible, coinsurance, copayment or similar 10
out-of-pocket expense. 11
(2) "Diagnostic breast examinations" means a medically necessary and appropriate 12
examination of the breast, including an examination using diagnostic mammography, breast 13
magnetic resonance imaging, or breast ultrasound, that is: 14
(i) Used to evaluate an abnormality seen or suspected from a screening examination for 15
breast cancer; or 16
(ii) Used to evaluate an abnormality detected by another means of examination. 17
(3) "Supplemental breast examinations" means a medically necessary and appropriate 18
examination of the breast, including an examination using breast magnetic resonance imaging, or 19
breast ultrasound, that is: 20
(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and 21
(ii) Based on personal or family medical history, or additional factors that may increase the 22
individual’s risk of breast cancer. 23
(b) In the case that a group health plan, or a health insurance issuer offering group or 24
individual health insurance coverage, that provides benefits with respect to screening, supplemental 25
and diagnostic breast examinations furnished to an individual enrolled under such plan or such 26
coverage, the plan or coverage shall not impose any cost-sharing requirements. 27
SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service 28
Corporations" is hereby amended by adding thereto the following section: 29
27-20-17.2. Diagnostic and supplemental breast examination. 30
(a) As used in this section, the following words shall have the following meanings: 31
(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any 32
maximum limitation on the application of such a deductible, coinsurance, copayment or similar 33
out-of-pocket expense. 34
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(2) "Diagnostic breast examinations" means a medically necessary and appropriate 1
examination of the breast, including an examination using diagnostic mammography, breast 2
magnetic resonance imaging, or breast ultrasound, that is: 3
(i) Used to evaluate an abnormality seen or suspected from a screening examination for 4
breast cancer; or 5
(ii) Used to evaluate an abnormality detected by another means of examination. 6
(3) "Supplemental breast examinations" means a medically necessary and appropriate 7
examination of the breast, including an examination using breast magnetic resonance imaging, or 8
breast ultrasound, that is: 9
(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and 10
(ii) Based on personal or family medical history, or additional factors that may increase the 11
individual’s risk of breast cancer. 12
(b) In the case that a group health plan, or a health insurance issuer offering group or 13
individual health insurance coverage, that provides benefits with respect to screening, supplemental 14
and diagnostic breast examinations furnished to an individual enrolled under such plan or such 15
coverage, the plan or coverage shall not impose any cost-sharing requirements. 16
SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance 17
Organizations" is hereby amended by adding thereto the following section: 18
27-41-30.2. Diagnostic and supplemental breast examination. 19
(a) As used in this section, the following words shall have the following meanings: 20
(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any 21
maximum limitation on the application of such a deductible, coinsurance, copayment or similar 22
out-of-pocket expense. 23
(2) "Diagnostic breast examinations" means a medically necessary and appropriate 24
examination of the breast, including an examination using diagnostic mammography, breast 25
magnetic resonance imaging, or breast ultrasound, that is: 26
(i) Used to evaluate an abnormality seen or suspected from a screening examination for 27
breast cancer; or 28
(ii) Used to evaluate an abnormality detected by another means of examination. 29
(3) "Supplemental breast examinations" means a medically necessary and appropriate 30
examination of the breast, including an examination using breast magnetic resonance imaging, or 31
breast ultrasound, that is: 32
(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and 33
(ii) Based on personal or family medical history, or additional factors that may increase the 34
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individual’s risk of breast cancer. 1
(b) In the case that a group health plan, or a health insurance issuer offering group or 2
individual health insurance coverage, that provides benefits with respect to screening, supplemental 3
and diagnostic breast examinations furnished to an individual enrolled under such plan or such 4
coverage, the plan or coverage shall not impose any cost-sharing requirements. 5
SECTION 5. This act shall take effect on January 1, 2026. 6
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
***
This act would prohibit an insurance company from imposing any cost-sharing 1
requirements for any diagnostic or supplemental breast examinations. 2
This act would take effect on January 1, 2026. 3
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