THE BILL ITSELF
HB 137
Coverage for Mammograms and Supplemental Breast Cancer Screenings
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A bill to be entitled
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An act relating to coverage for mammograms and
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supplemental breast cancer screenings; creating s.
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409.9064, F.S.; providing definitions; requiring the
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Agency for Health Care Administration to provide
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coverage for yearly mammograms and yearly supplemental
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breast cancer screenings for certain women under the
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Medicaid program under certain circumstances;
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requiring the agency to seek federal approval under a
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specified circumstance; amending ss. 627.6418,
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627.6613, and 641.31095, F.S.; defining the term
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"supplemental breast cancer screening"; revising
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coverages for mammograms under certain individual
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accident and health insurance policies, group,
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blanket, and franchise accident and health insurance
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policies, and health maintenance contracts,
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respectively; requiring coverages for supplemental
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breast cancer screenings under such policies and
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contracts under certain circumstances; providing
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applicability; providing an effective date.
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Section 409.9064, Florida Statutes, is created
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to read:
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409.9064 Coverage for mammograms and supplemental breast
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cancer screenings.—
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(1) As used in this section, the term:
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(a) "Mammogram" means an image of a radiologic examination
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used to detect unsuspected breast cancer at an early stage in an
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asymptomatic woman and includes the X-ray picture of the breast
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using equipment that is dedicated specifically for mammography,
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including, but not limited to, the X-ray tube, filter,
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compression device, screens, film, and cassettes. The radiologic
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examination must include two views of each breast. The term also
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includes images from digital breast tomosynthesis and the
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professional interpretation of images from any mammography
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equipment, but does not include any diagnostic mammography
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image.
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(b) "Supplemental breast cancer screening" means a
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clinically appropriate examination, in addition to a mammogram,
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deemed medically necessary by a treating health care provider
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for breast cancer screening in accordance with applicable
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American College of Radiology guidelines, including, but not
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limited to, magnetic resonance imaging, ultrasound, and
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molecular breast imaging.
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(2) Subject to the availability of funds and subject to
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any limitations or directions provided in the General
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Appropriations Act, the agency must provide the following
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coverage each year for a Medicaid recipient who is a woman
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between 25 and 40 years of age, inclusive:
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(a) One mammogram to detect the presence of breast cancer.
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(b) One supplemental breast cancer screening to detect the
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presence of breast cancer if:
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1. The woman's mammogram demonstrates, based on the breast
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imaging reporting and data system established by the American
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College of Radiology, that the woman has dense breast tissue; or
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2. The woman is at an increased risk of breast cancer due
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to:
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a. A personal or family history of breast cancer;
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b. A personal history of biopsy-proven benign breast
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disease;
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c. Ancestry;
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d. Genetic predisposition;
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e. Not having given birth before the age of 30; or
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f. Other reasons as determined by the woman's physician.
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(3) The agency shall seek federal approval, if needed, for
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the implementation of this section.
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Section 2. Section 627.6418, Florida Statutes, is amended,
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to read:
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627.6418 Coverage for mammograms and supplemental breast
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cancer screenings.—
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(1) As used in this section, the term "supplemental breast
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cancer screening" means a clinically appropriate examination, in
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addition to a mammogram, deemed medically necessary by a
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treating physician for breast cancer screening in accordance
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with applicable American College of Radiology guidelines,
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including, but not limited to, magnetic resonance imaging,
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ultrasound, and molecular breast imaging.
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(2)(1) An accident or health insurance policy issued,
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amended, delivered, or renewed in this state on or after July 1,
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2026, must provide coverage for at least the following for any
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woman between 25 and 40 years of age, inclusive:
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(a) One A baseline mammogram each year, including a
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digital breast tomosynthesis for any woman who is 35 years of
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age or older, but younger than 40 years of age.
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(b) A mammogram every 2 years for any woman who is 40
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years of age or older, but younger than 50 years of age, or more
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frequently based on the patient's physician's recommendation.
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(c) A mammogram every year for any woman who is 50 years
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of age or older.
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(b)(d) One supplemental breast cancer screening each or
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more mammograms a year, based upon a physician's recommendation,
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if the for any woman who is at risk for breast cancer because of
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dense breast tissue as the woman's mammogram demonstrates, based
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on the breast imaging reporting and data system established by
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the American College of Radiology; because of a personal or
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family history of breast cancer;, because of having a personal
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history of biopsy-proven benign breast disease; because of
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ancestry; because of genetic predisposition;, because of having
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a mother, sister, or daughter who has or has had breast cancer,
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or because the a woman has not given birth before the age of 30;
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or because of other reasons as determined by the woman's
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physician.
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(3)(2) Except as provided in paragraph (1)(b), for
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mammograms done more frequently than every 2 years for women 40
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years of age or older but younger than 50 years of age, The
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coverage required by subsection (2) (1) applies, with or without
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a physician prescription, if the insured obtains a mammogram or,
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if applicable, a supplemental breast cancer screening in an
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office, facility, or health testing service that uses
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radiological equipment registered with the Department of Health
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for breast cancer screening. The coverage is subject to the
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deductible and coinsurance provisions applicable to outpatient
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visits, and is also subject to all other terms and conditions
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applicable to other benefits. This section does not affect any
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requirements or prohibitions relating to who may perform,
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analyze, or interpret a mammogram or the persons to whom the
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results of a mammogram may be furnished or released.
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(4)(3) This section does not apply to disability income,
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specified disease, or hospital indemnity policies.
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(5)(4) Every insurer subject to the requirements of this
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section shall make available to the policyholder as part of the
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application, for an appropriate additional premium, the coverage
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required in this section without such coverage being subject to
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the deductible or coinsurance provisions of the policy.
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Section 3. Section 627.6613, Florida Statutes, is amended
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to read:
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627.6613 Coverage for mammograms and supplemental breast
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cancer screenings.—
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(1) As used in this section, the term "supplemental breast
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cancer screening" means a clinically appropriate examination, in
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addition to a mammogram, deemed medically necessary by a
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treating physician for breast cancer screening in accordance
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with applicable American College of Radiology guidelines,
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including, but not limited to, magnetic resonance imaging,
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ultrasound, and molecular breast imaging.
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(2)(1) A group, blanket, or franchise accident or health
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insurance policy issued, amended, delivered, or renewed in this
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state on or after July 1, 2026, must provide coverage for at
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least the following for any woman between 25 and 40 years of
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age, inclusive:
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(a) One A baseline mammogram each year, including a
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digital breast tomosynthesis for any woman who is 35 years of
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age or older, but younger than 40 years of age.
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(b) A mammogram every 2 years for any woman who is 40
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years of age or older, but younger than 50 years of age, or more
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frequently based on the patient's physician's recommendation.
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(c) A mammogram every year for any woman who is 50 years
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of age or older.
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(b)(d) One supplemental breast cancer screening each or
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more mammograms a year, based upon a physician's recommendation,
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if the for any woman who is at risk for breast cancer because of
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dense breast tissue as the woman's mammogram demonstrates, based
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on the breast imaging reporting and data system established by
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the American College of Radiology; because of a personal or
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family history of breast cancer;, because of having a personal
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history of biopsy-proven benign breast disease; because of
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ancestry; because of genetic predisposition;, because of having
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a mother, sister, or daughter who has or has had breast cancer,
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or because the a woman has not given birth before the age of 30;
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or because of other reasons as determined by the woman's
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physician.
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(3)(2) Except as provided in paragraph (1)(b), for
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mammograms done more frequently than every 2 years for women 40
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years of age or older but younger than 50 years of age, The
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coverage required by subsection (2) (1) applies, with or without
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a physician prescription, if the insured obtains a mammogram or,
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if applicable, a supplemental breast cancer screening in an
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office, facility, or health testing service that uses
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radiological equipment registered with the Department of Health
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for breast cancer screening. The coverage is subject to the
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deductible and coinsurance provisions applicable to outpatient
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visits, and is also subject to all other terms and conditions
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applicable to other benefits. This section does not affect any
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requirements or prohibitions relating to who may perform,
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analyze, or interpret a mammogram or the persons to whom the
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results of a mammogram may be furnished or released.
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(4)(3) Every insurer referred to in subsection (2) (1)
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shall make available to the policyholder as part of the
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application, for an appropriate additional premium, the coverage
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required in this section without such coverage being subject to
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the deductible or coinsurance provisions of the policy.
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Section 4. Section 641.31095, Florida Statutes, is amended
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to read:
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641.31095 Coverage for mammograms and supplemental breast
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cancer screenings.—
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(1) As used in this section, the term "supplemental breast
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cancer screening" means a clinically appropriate examination, in
190
addition to a mammogram, deemed medically necessary by a
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treating physician for breast cancer screening in accordance
192
with applicable American College of Radiology guidelines,
193
including, but not limited to, magnetic resonance imaging,
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ultrasound, and molecular breast imaging.
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(2)(1) Every health maintenance contract issued or renewed
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on or after July 1, 2026, must January 1, 1996, shall provide
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coverage for at least the following for any woman between 25 and
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40 years of age, inclusive:
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(a) One A baseline mammogram each year, including a
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digital breast tomosynthesis for any woman who is 35 years of
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age or older, but younger than 40 years of age.
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(b) A mammogram every 2 years for any woman who is 40
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years of age or older, but younger than 50 years of age, or more
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frequently based on the patient's physician's recommendations.
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(c) A mammogram every year for any woman who is 50 years
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of age or older.
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(b)(d) One supplemental breast cancer screening each or
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more mammograms a year, based upon a physician's recommendation,
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if the for any woman who is at risk for breast cancer because of
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dense breast tissue as the woman's mammogram demonstrates, based
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on the breast imaging reporting and data system established by
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the American College of Radiology; because of a personal or
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family history of breast cancer;, because of having a personal
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history of biopsy-proven benign breast disease; because of
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ancestry; because of genetic predisposition;, because of having
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a mother, sister, or daughter who has had breast cancer, or
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because the a woman has not given birth before the age of 30; or
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because of other reasons as determined by the woman's physician.
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(3)(2) The coverage required by this section is subject to
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the deductible and copayment provisions applicable to outpatient
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visits, and is also subject to all other terms and conditions
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applicable to other benefits. A health maintenance organization
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shall make available to the subscriber as part of the
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application, for an appropriate additional premium, the coverage
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required in this section without such coverage being subject to
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any deductible or copayment provisions in the contract.
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Section 5. This act shall take effect July 1, 2026.