An Act to prohibit cost sharing in certain health insurance policies for diagnostic and supplemental breast imaging examinations.

Be it enacted by the Legislature of the State of South Dakota:

Section 1. That chapter 58-17 be amended with a NEW SECTION:

A health insurance policy may not impose any cost-sharing requirements with respect to screening, diagnostic breast examinations, and supplemental breast examinations furnished to an individual enrolled under the policy.

Terms used in this section mean:

(1) "Cost-sharing requirement," a deductible, coinsurance, copayment, or similar out-of-pocket expense;

(2) "Diagnostic breast examination," a medically necessary and appropriate examination of the breast, in accordance with National Comprehensive Cancer Network Guidelines, including diagnostic mammography, contrast-enhanced mammography, breast magnetic resonance imaging, or breast ultrasound, that is:

(a) Used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or

(b) Used to evaluate an abnormality detected by another means of examination; and

(3) "Supplemental breast examination," a medically necessary and appropriate examination of the breast, in accordance with National Comprehensive Cancer Network Guidelines, including diagnostic mammography, contrast-enhanced mammography, breast magnetic resonance imaging, or breast ultrasound, that is:

(a) Used to screen for breast cancer when there is no abnormality seen or suspected; and

(b) Based on personal or family medical history, or additional factors that may increase the individual’s risk of breast cancer.

Section 2. That chapter 58-18 be amended with a NEW SECTION:

A group health insurance policy may not impose any cost-sharing requirements with respect to screening, diagnostic breast examinations, and supplemental breast examinations furnished to an individual enrolled under the policy.

Terms used in this section mean:

(1) "Cost-sharing requirement," a deductible, coinsurance, copayment, or similar out-of-pocket expense;

(2) "Diagnostic breast examination," a medically necessary and appropriate examination of the breast, in accordance with National Comprehensive Cancer Network Guidelines, including diagnostic mammography, contrast-enhanced mammography, breast magnetic resonance imaging, or breast ultrasound, that is:

(a) Used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or

(b) Used to evaluate an abnormality detected by another means of examination; and

(3) "Supplemental breast examination," a medically necessary and appropriate examination of the breast, in accordance with National Comprehensive Cancer Network Guidelines, including diagnostic mammography, contrast-enhanced mammography, breast magnetic resonance imaging, or breast ultrasound, that is:

(a) Used to screen for breast cancer when there is no abnormality seen or suspected; and

(b) Based on personal or family medical history, or additional factors that may increase the individual’s risk of breast cancer.