Present law requires a health benefit plan that provides coverage for imaging services for screening mammography to provide coverage to a patient for low-dose mammography according to the following guidelines:
(1) A baseline mammogram for a woman 35 to 40 years of age;
(2) A yearly mammogram for a woman 35 to 40 years of age if the woman is at high risk based upon personal family medical history, dense breast tissue, or additional factors that may increase the individual's risk of breast cancer; and
(3) A yearly mammogram for a woman 40 years of age or older based on the recommendation of the woman's licensed physician.
Present law also requires a health benefit plan that provides coverage for a screening mammogram to provide coverage for diagnostic imaging and supplemental breast screening. This bill would provide that the health benefit plan would have to provide this coverage without imposing a deductible, coinsurance, copayment, or a maximum limitation on the application of the deductible, coinsurance, copayment, or other out-of-pocket expense on the patient.
ON APRIL 20, 2023, THE HOUSE ADOPTED AMENDMENT #1 AND PASSED HOUSE BILL 355, AS AMENDED.
AMENDMENT #1 establishes an exemption to the no-cost sharing requirement, which provides that if the coverage would result in a high deductible health benefit plan with a health savings account becoming ineligible under the Internal Revenue Code, then the new coverage only applies to such plans only after the plan enrollee has satisfied the minimum deductible required under the Internal Revenue Code, except with respect to items or services that are deemed preventive care pursuant to the Internal Revenue Code.
ON APRIL 21, 2023, THE SENATE SUBSTITUTED HOUSE BILL 355 FOR SENATE BILL 365, ADOPTED AMENDMENT #2, AND PASSED HOUSE BILL 355, AS AMENDED.
AMENDMENT #2 changes the effective date to 90 days after the date this bill becomes a law.

Statutes affected:
Introduced: 56-7-2502(a), 56-7-2502, 56-7-2502(c)