THE BILL ITSELF
SB 1494
Insurance Coverage for Breast Cancer Screening
Florida Senate - 2026 SB 1494 By Senator Davis 5-01179C-26 20261494__
1
A bill to be entitled
2
An act relating to insurance coverage for breast
3
cancer screening; amending s. 627.6418, F.S.; defining
4
terms; requiring that certain health insurance
5
policies issued, amended, delivered, or renewed on or
6
after a specified date provide specified minimum
7
coverage for breast cancer screening and diagnosis;
8
specifying that specified health insurance policies
9
are subject to certain provisions; revising
10
applicability; amending s. 627.6613, F.S.; defining
11
terms; requiring that certain health insurance
12
policies issued, amended, delivered, or renewed on or
13
after a specified date provide specified minimum
14
coverage for breast cancer screening and diagnosis;
15
specifying that specified health insurance policies
16
are subject to certain provisions; amending s.
17
627.6699, F.S.; defining terms; requiring that certain
18
health benefit plans issued on or after a specified
19
date provide specified minimum coverage for breast
20
cancer screening and diagnosis; specifying that
21
specified health insurance policies are subject to
22
certain provisions; providing applicability; providing
23
construction; requiring insurers to make certain
24
coverage available to the policyholder or contract
25
holder without being subject to certain deductible or
26
coinsurance provisions; amending s. 641.31095, F.S.;
27
defining terms; requiring that certain health
28
maintenance contracts issued or renewed on or after a
29
specified date provide specified minimum coverage for
30
breast cancer screening and diagnosis; specifying that
31
specified health insurance policies are subject to
32
certain provisions; providing an effective date.
34
Be It Enacted by the Legislature of the State of Florida:
36
Section 1. Section 627.6418, Florida Statutes, is amended
37
to read:
38
627.6418 Coverage for mammograms.—
39
(1) As used in this section, the term:
40
(a) “BI-RADS” means the American College of Radiology
41
Breast Imaging Reporting and Data System.
42
(b) “Diagnostic breast examination” means a medically
43
necessary imaging examination of the breast, including, but not
44
limited to, an examination using diagnostic mammography, breast
45
magnetic resonance imaging, or breast ultrasound, which is used
46
to evaluate an abnormality that is seen or reasonably suspected
47
during a screening examination for breast cancer. For purposes
48
of this paragraph, the term “reasonably suspected” means the
49
screening examination evidences at least one observable sign of
50
a potential abnormality.
51
(c) “Increased risk” means, in accordance with the National
52
Comprehensive Cancer Network, any one of the following
53
categories which enhances the likelihood that a woman may
54
develop breast cancer, including:
55
1. Having a known genetic predisposition or a pedigree
56
suggestive of a genetic predisposition for breast cancer.
57
2. Having a lifetime risk of breast cancer equal to or
58
greater than 20 percent as defined by models that include a
59
comprehensive family history, including first-, second-, and,
60
when relevant to the model, third-degree relatives.
61
3. Having previously received thoracic radiation between 10
62
and 30 years of age.
63
4. Being 35 years of age or older with a 5-year risk of
64
invasive breast cancer equal to or greater than 1.7 percent.
65
5. Having a lifetime risk equal to or greater than 20
66
percent based on a history of atypical ductal hyperplasia,
67
lobular carcinoma in situ, or atypical lobular hyperplasia.
68
6. Having heterogeneously or extremely dense breast tissue
69
as defined under the BI-RADS and based on a woman’s most
70
recently completed mammogram results.
71
(d) “Screening mammogram” means a radiologic examination
72
using equipment dedicated specifically for mammography,
73
including digital breast tomosynthesis mammography but not
74
including any diagnostic mammography imaging, for the purpose of
75
detecting any potential breast cancer, which examination results
76
in the production of at least two radiographic images of each
77
breast.
78
(e) “Supplemental breast cancer screening” means an imaging
79
examination of the breast, including, but not limited to, breast
80
magnetic resonance imaging, breast ultrasound, contrast-enhanced
81
mammography, or molecular breast imaging, which is used to
82
screen for breast cancer when there is no abnormality seen or
83
suspected.
84
(2) (1) A major medical or similar comprehensive An accident
85
or health insurance policy issued, amended, delivered, or
86
renewed in this state on or after January 1, 2027, must provide
87
all of the following minimum coverage in accordance with the
88
most recent applicable National Comprehensive Cancer Network’s
89
Breast Cancer Screening and Diagnosis guidelines coverage for at
90
least the following :
91
(a) A baseline mammogram for any woman who is 35 years of
92
age or older, but younger than 40 years of age.
93
(b) A mammogram every 2 years for any woman who is 40 years
94
of age or older, but younger than 50 years of age, or more
95
frequently based on the patient’s physician’s recommendation.
96
(c) A screening mammogram every year for any woman who is
97
40 50 years of age or older.
98
(b) (d) One or more medically necessary screening mammograms
99
a year, based upon a physician’s recommendation of a physician
100
licensed under chapter 458 or chapter 459 , for any woman who is
101
at an increased risk of developing for breast cancer because of
102
a personal or family history of breast cancer, because of having
103
a history of biopsy-proven benign breast disease, because of
104
having a mother, sister, or daughter who has or has had breast
105
cancer, or because a woman has not given birth before the age of
106
30 .
107
(c) One medically necessary supplemental breast cancer
108
screening a year, based upon a recommendation of a physician
109
licensed under chapter 458 or chapter 459, for any woman who is
110
at an increased risk of developing breast cancer.
111
(3) A major medical or similar comprehensive health
112
insurance policy issued for an insured who has dense breast
113
tissue by itself in the absence of any evidence of an
114
abnormality or suspicious abnormality of the breast as defined
115
by BI-RADS is subject to the coverage requirements provided in
116
paragraphs (2)(b) and (c).
117
(4) A major medical or similar comprehensive health
118
insurance policy is subject to this section after treatment for
119
any breast cancer is completed, even if the insured is in a
120
remission and surveillance period prior to any clinical
121
designation that the insured is in long-term remission or cured,
122
provided any examination conducted during such period does not
123
meet the definition of a diagnostic breast examination.
124
(5) (2) Except as provided in paragraph (1)(b), for
125
mammograms done more frequently than every 2 years for women 40
126
years of age or older but younger than 50 years of age, The
127
coverage required by paragraphs (2)(a) and (b) subsection (1)
128
applies, with or without a licensed treating physician’s
129
physician prescription, if the insured obtains a screening
130
mammogram in an office, facility, or health testing service that
131
uses radiological equipment registered with the Department of
132
Health for breast cancer screening. The coverage is subject to
133
the deductible and coinsurance provisions applicable to
134
outpatient visits, and is also subject to all other terms and
135
conditions applicable to other benefits. This section does not
136
affect any requirements or prohibitions relating to who may
137
perform, analyze, or interpret a screening mammogram or the
138
persons to whom the results of a screening mammogram may be
139
furnished or released.
140
(6) (3) This section applies does not apply to disability
141
income, specified disease, or hospital indemnity policies
142
providing major medical or similar comprehensive coverage or
143
benefits .
144
(7) (4) Every insurer subject to the requirements of this
145
section shall make available to the policyholder as part of the
146
application, for an appropriate additional premium, the coverage
147
required in this section without such coverage being subject to
148
the deductible or coinsurance provisions of the policy.
149
Section 2. Section 627.6613, Florida Statutes, is amended
150
to read:
151
627.6613 Coverage for mammograms.—
152
(1) As used in this section, the term:
153
(a) “BI-RADS” means the American College of Radiology
154
Breast Imaging Reporting and Data System.
155
(b) “Diagnostic breast examination” means a medically
156
necessary imaging examination of the breast, including, but not
157
limited to, an examination using diagnostic mammography, breast
158
magnetic resonance imaging, or breast ultrasound, which is used
159
to evaluate an abnormality that is seen or reasonably suspected
160
during a screening examination for breast cancer. For purposes
161
of this paragraph, the term “reasonably suspected” means the
162
screening examination evidences at least one observable sign of
163
a potential abnormality.
164
(c) “Increased risk” means, in accordance with the National
165
Comprehensive Cancer Network, any one of the following
166
categories which enhances the likelihood that a woman may
167
develop breast cancer, including:
168
1. Having a known genetic predisposition or a pedigree
169
suggestive of a genetic predisposition for breast cancer.
170
2. Having a lifetime risk of breast cancer equal to or
171
greater than 20 percent as defined by models that include a
172
comprehensive family history, including first-, second-, and,
173
when relevant to the model, third-degree relatives.
174
3. Having previously received thoracic radiation between 10
175
and 30 years of age.
176
4. Being 35 years of age or older with a 5-year risk of
177
invasive breast cancer equal to or greater than 1.7 percent.
178
5. Having a lifetime risk equal to or greater than 20
179
percent based on a history of atypical ductal hyperplasia,
180
lobular carcinoma in situ, or atypical lobular hyperplasia.
181
6. Having heterogeneously or extremely dense breast tissue
182
as defined under the BI-RADS and based on a woman’s most
183
recently completed mammogram results.
184
(d) “Screening mammogram” means a radiologic examination
185
using equipment dedicated specifically for mammography,
186
including digital breast tomosynthesis mammography but not
187
including any diagnostic mammography imaging, for the purpose of
188
detecting any potential breast cancer, which examination results
189
in the production of at least two radiographic images of each
190
breast.
191
(e) “Supplemental breast cancer screening” means an imaging
192
examination of the breast, including, but not limited to, breast
193
magnetic resonance imaging, breast ultrasound, contrast-enhanced
194
mammography, or molecular breast imaging, which is used to
195
screen for breast cancer when there is no abnormality seen or
196
suspected.
197
(2) (1) A group, blanket, or franchise major medical or
198
similar comprehensive accident or health insurance policy
199
issued, amended, delivered, or renewed in this state on or after
200
January 1, 2027, must provide all of the following minimum
201
coverage in accordance with the most recent applicable National
202
Comprehensive Cancer Network’s Breast Cancer Screening and
203
Diagnosis guidelines coverage for at least the following :
204
(a) A baseline mammogram for any woman who is 35 years of
205
age or older, but younger than 40 years of age.
206
(b) A mammogram every 2 years for any woman who is 40 years
207
of age or older, but younger than 50 years of age, or more
208
frequently based on the patient’s physician’s recommendation.
209
(c) A screening mammogram every year for any woman who is
210
40 50 years of age or older.
211
(b) (d) One or more medically necessary screening mammograms
212
a year, based upon a physician’s recommendation of a physician
213
licensed under chapter 458 or chapter 459 , for any woman who is
214
at an increased risk of developing for breast cancer because of
215
a personal or family history of breast cancer, because of having
216
a history of biopsy-proven benign breast disease, because of
217
having a mother, sister, or daughter who has or has had breast
218
cancer, or because a woman has not given birth before the age of
219
30 .
220
(c) One medically necessary supplemental breast cancer
221
screening a year, based upon a recommendation of a physician
222
licensed under chapter 458 or chapter 459, for any woman who is
223
at an increased risk of developing breast cancer.
224
(3) A group, blanket, or franchise major medical or similar
225
comprehensive health insurance policy issued for an insured who
226
has dense breast tissue by itself in the absence of any evidence
227
of an abnormality or suspicious abnormality of the breast as
228
defined by BI-RADS is subject to the coverage requirements
229
provided in paragraphs (2)(b) and (c).
230
(4) A group, blanket, or franchise major medical or similar
231
comprehensive health insurance policy is subject to this section
232
after treatment for any breast cancer is completed, even if the
233
insured is in a remission and surveillance period prior to any
234
clinical designation that the insured is in long-term remission
235
or cured, provided any examination conducted during such period
236
does not meet the definition of a diagnostic breast examination.
237
(5) (2) Except as provided in paragraph (1)(b), for
238
mammograms done more frequently than every 2 years for women 40
239
years of age or older but younger than 50 years of age, The
240
coverage required by paragraphs (2)(a) and (b) subsection (1)
241
applies, with or without a licensed treating physician’s
242
physician prescription, if the insured obtains a screening
243
mammogram in an office, facility, or health testing service that
244
uses radiological equipment registered with the Department of
245
Health for breast cancer screening. The coverage is subject to
246
the deductible and coinsurance provisions applicable to
247
outpatient visits, and is also subject to all other terms and
248
conditions applicable to other benefits. This section does not
249
affect any requirements or prohibitions relating to who may
250
perform, analyze, or interpret a screening mammogram or the
251
persons to whom the results of a screening mammogram may be
252
furnished or released.
253
(6) (3) Every insurer referred to in subsection (1) shall
254
make available to the policyholder as part of the application,
255
for an appropriate additional premium, the coverage required in
256
this section without such coverage being subject to the
257
deductible or coinsurance provisions of the policy.
258
Section 3. Present subsection (17) of section 627.6699,
259
Florida Statutes, is redesignated as subsection (18), and a new
260
subsection (17) is added to that section, to read:
261
627.6699 Employee Health Care Access Act.—
262
(17) COVERAGE FOR MAMMOGRAMS.—
263
(a) As used in this subsection, the term:
264
1. “BI-RADS” means the American College of Radiology Breast
265
Imaging Reporting and Data System.
266
2. “Diagnostic breast examination” means a medically
267
necessary imaging examination of the breast, including, but not
268
limited to, an examination using diagnostic mammography, breast
269
magnetic resonance imaging, or breast ultrasound, which is used
270
to evaluate an abnormality that is seen or reasonably suspected
271
during a screening examination for breast cancer. For purposes
272
of this subparagraph, the term “reasonably suspected” means the
273
screening examination evidences at least one observable sign of
274
a potential abnormality.
275
3. “Increased risk” means, in accordance with the National
276
Comprehensive Cancer Network, any one of the following
277
categories which enhances the likelihood that a woman may
278
develop breast cancer, including:
279
a. Having a known genetic predisposition or a pedigree
280
suggestive of a genetic predisposition for breast cancer.
281
b. Having a lifetime risk of breast cancer equal to or
282
greater than 20 percent as defined by models that include a
283
comprehensive family history, including first-, second-, and,
284
when relevant to the model, third-degree relatives.
285
c. Having previously received thoracic radiation between 10
286
and 30 years of age.
287
d. Being 35 years of age or older with a 5-year risk of
288
invasive breast cancer equal to or greater than 1.7 percent.
289
e. Having a lifetime risk equal to or greater than 20
290
percent based on a history of atypical ductal hyperplasia,
291
lobular carcinoma in situ, or atypical lobular hyperplasia.
292
f. Having heterogeneously or extremely dense breast tissue
293
as defined under the BI-RADS and based on a woman’s most
294
recently completed mammogram results.
295
4. “Screening mammogram” means a radiologic examination
296
using equipment dedicated specifically for mammography,
297
including digital breast tomosynthesis mammography but not
298
including any diagnostic mammography imaging, for the purpose of
299
detecting any potential breast cancer, which examination results
300
in the production of at least two radiographic images of each
301
breast.
302
5. “Supplemental breast cancer screening” means an imaging
303
examination of the breast, including, but not limited to, breast
304
magnetic resonance imaging, breast ultrasound, contrast-enhanced
305
mammography, or molecular breast imaging, which is used to
306
screen for breast cancer when there is no abnormality seen or
307
suspected.
308
(b) A health benefit plan issued in this state on or after
309
January 1, 2027, must provide for all of the following minimum
310
coverage in accordance with the most recent applicable National
311
Comprehensive Cancer Network’s Breast Cancer Screening and
312
Diagnosis guidelines:
313
1. A screening mammogram every year for any woman who is 40
314
years of age or older.
315
2. One or more medically necessary screening mammograms a
316
year, based upon a recommendation of a physician licensed under
317
chapter 458 or chapter 459, for any woman who is at an increased
318
risk of developing breast cancer.
319
3. One medically necessary supplemental breast cancer
320
screening a year, based upon a recommendation of a physician
321
licensed under chapter 458 or chapter 459, for any woman who is
322
at an increased risk of developing breast cancer.
323
(c) A health benefit plan issued for an insured who has
324
dense breast tissue by itself in the absence of any evidence of
325
an abnormality or suspicious abnormality of the breast as
326
defined by BI-RADS is subject to the coverage requirements
327
provided in subparagraphs (b)2. and 3.
328
(d) A health benefit plan is subject to this section after
329
treatment for any breast cancer is completed, even if the
330
insured is in a remission and surveillance period prior to any
331
clinical designation that the insured is in long-term remission
332
or cured provided any examination conducted during such period
333
does not meet the definition of a diagnostic breast examination.
334
(e) The coverage required by subparagraphs (b)2. and 3.
335
applies, with or without a licensed treating physician’s
336
prescription, if the insured obtains a screening mammogram in an
337
office, facility, or health testing service that uses
338
radiological equipment registered with the Department of Health
339
for breast cancer screening. The coverage is subject to the
340
deductible and coinsurance provisions applicable to outpatient
341
visits and is also subject to all other terms and conditions
342
applicable to other benefits. This section does not affect any
343
requirements or prohibitions relating to who may perform,
344
analyze, or interpret a screening mammogram or the persons to
345
whom the results of a screening mammogram may be furnished or
346
released.
347
(f) This subsection applies to policies providing health
348
benefit plan coverage or benefits.
349
(g) Every insurer subject to the requirements of this
350
subsection shall make available to the policyholder or contract
351
holder as part of the application, for an appropriate additional
352
premium, the coverage required in this subsection without such
353
coverage being subject to the deductible or coinsurance
354
provisions of the policy.
355
Section 4. Section 641.31095, Florida Statutes, is amended
356
to read:
357
641.31095 Coverage for mammograms.—
358
(1) As used in this section, the term:
359
(a) “BI-RADS” means the American College of Radiology
360
Breast Imaging Reporting and Data System.
361
(b) “Diagnostic breast examination” means a medically
362
necessary imaging examination of the breast, including, but not
363
limited to, an examination using diagnostic mammography, breast
364
magnetic resonance imaging, or breast ultrasound, which is used
365
to evaluate an abnormality that is seen or reasonably suspected
366
during a screening examination for breast cancer. For purposes
367
of this paragraph, the term “reasonably suspected” means the
368
screening examination evidences at least one observable sign of
369
a potential abnormality.
370
(c) “Increased risk” means, in accordance with the National
371
Comprehensive Cancer Network, any one of the following
372
categories which enhances the likelihood that a woman may
373
develop breast cancer, including:
374
1. Having a known genetic predisposition or a pedigree
375
suggestive of a genetic predisposition for breast cancer.
376
2. Having a lifetime risk of breast cancer equal to or
377
greater than 20 percent as defined by models that include a
378
comprehensive family history, including first-, second-, and,
379
when relevant to the model, third-degree relatives.
380
3. Having previously received thoracic radiation between 10
381
and 30 years of age.
382
4. Being 35 years of age or older with a 5-year risk of
383
invasive breast cancer equal to or greater than 1.7 percent.
384
5. Having a lifetime risk equal to or greater than 20
385
percent based on a history of atypical ductal hyperplasia,
386
lobular carcinoma in situ, or atypical lobular hyperplasia.
387
6. Having heterogeneously or extremely dense breast tissue
388
as defined under the BI-RADS and based on a woman’s most
389
recently completed mammogram results.
390
(d) “Screening mammogram” means a radiologic examination
391
using equipment dedicated specifically for mammography,
392
including digital breast tomosynthesis mammography but not
393
including any diagnostic mammography imaging, for the purpose of
394
detecting any potential breast cancer, which examination results
395
in the production of at least two radiographic images of each
396
breast.
397
(e) “Supplemental breast cancer screening” means an imaging
398
examination of the breast, including, but not limited to, breast
399
magnetic resonance imaging, breast ultrasound, contrast-enhanced
400
mammography, or molecular breast imaging, which is used to
401
screen for breast cancer when there is no abnormality seen or
402
suspected.
403
(2) (1) Every health maintenance contract issued or renewed
404
on or after January 1, 2027 1996 , shall provide for all of the
405
following minimum coverage in accordance with the most recent
406
applicable National Comprehensive Cancer Network’s Breast Cancer
407
Screening and Diagnosis guidelines coverage for at least the
408
following :
409
(a) A baseline mammogram for any woman who is 35 years of
410
age or older, but younger than 40 years of age.
411
(b) A mammogram every 2 years for any woman who is 40 years
412
of age or older, but younger than 50 years of age, or more
413
frequently based on the patient’s physician’s recommendations.
414
(c) A screening mammogram every year for any woman who is
415
40 50 years of age or older.
416
(b) (d) One or more medically necessary screening mammograms
417
and one supplemental breast cancer screening mammograms a year,
418
based upon a physician’s recommendation of a physician licensed
419
under chapter 458 or chapter 459, for any woman who is at an
420
increased risk of developing for breast cancer because of a
421
personal or family history of breast cancer, because of having a
422
history of biopsy-proven benign breast disease, because of
423
having a mother, sister, or daughter who has had breast cancer,
424
or because a woman has not given birth before the age of 30 .
425
(3) A health maintenance contract issued for a member who
426
has dense breast tissue by itself in the absence of any evidence
427
of an abnormality or suspicious abnormality of the breast as
428
defined by BI-RADS is subject to the coverage requirements
429
provided in paragraph (2)(b).
430
(4) A health maintenance contract is subject to this
431
section after treatment for any breast cancer is completed even
432
if the member is in a remission and surveillance period prior to
433
any clinical designation that the member is in long-term
434
remission or cured, provided any examination conducted during
435
such period does not meet the definition of a diagnostic breast
436
examination.
437
(5) (2) The coverage required by this section is subject to
438
the deductible and copayment provisions applicable to outpatient
439
visits, and is also subject to all other terms and conditions
440
applicable to other benefits. A health maintenance organization
441
shall make available to the subscriber as part of the
442
application, for an appropriate additional premium, the coverage
443
required in this section without such coverage being subject to
444
any deductible or copayment provisions in the contract.
445
Section 5. This act shall take effect July 1, 2026.