01-23 14:51 H.B. 314
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Breast Cancer Prevention Modifications
2025 GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Jennifer Dailey-Provost
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LONG TITLE
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General Description:
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This bill amends provisions related to health insurance and breast examinations that detect
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breast cancer.
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Highlighted Provisions:
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This bill:
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▸ defines terms; and
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▸ prohibits a health benefit plan from implementing a cost-sharing requirement for certain
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breast examinations that detect breast cancer.
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Money Appropriated in this Bill:
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None
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Other Special Clauses:
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None
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Utah Code Sections Affected:
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ENACTS:
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31A-22-630.1, Utah Code Annotated 1953
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Be it enacted by the Legislature of the state of Utah:
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Section 1. Section 31A-22-630.1 is enacted to read:
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31A-22-630.1 . Breast exam cost sharing.
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(1) As used in this section:
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(a) "Cost-sharing requirement" means any copayment, coinsurance, deductible, or
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annual limitation on out-of-pocket expenses required by a health benefit plan for a
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specific health care service covered by the health benefit plan.
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(b)(i) "Breast examination" means a medical examination of the breast conducted by
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a health care professional.
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(ii) "Breast examination" includes:
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(A) contrast-enhanced mammography;
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(B) diagnostic mammography; H.B. 314 01-23 14:51
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(C) breast magnetic resonance imaging; and
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(D) breast ultrasound.
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(c) "Diagnostic breast examination" means a medically necessary breast examination
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that is used to evaluate an abnormality that was detected or suspected after another
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means of examination, including a previous breast examination.
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(d) "Supplemental breast examination" means a medically necessary breast examination
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that is used to screen for breast cancer:
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(i) when there is no prior indication that a breast health abnormality exists or is
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suspected;
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(ii) based on personal or family medical history; or
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(iii) based on additional factors that increase an individual's risk of breast cancer.
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(2) A health benefit plan that provides benefits with respect to diagnostic breast
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examinations or supplemental breast examinations may not require an enrollee to pay a
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cost-sharing requirement for a diagnostic breast examination or a supplemental breast
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examination.
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(3) A diagnostic breast examination or a supplemental breast examination is medically
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necessary if the examination is provided in accordance with the National
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Comprehensive Cancer Network Guidelines.
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Section 2. Effective Date.
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This bill takes effect on May 7, 2025.
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