No. SB 1494
Filed under Insurance.
Insurance Coverage for Breast Cancer Screening; Requiring that certain health insurance policies issued, amended, delivered, or renewed on or after a specified date provide specified minimum coverage for breast cancer screening and diagnosis; requiring that certain health insurance policies issued, amended, delivered, or renewed on or after a specified date provide specified minimum coverage for breast cancer screening and diagnosis; requiring that certain health benefit plans issued on or after a specified date provide specified minimum coverage for breast cancer screening and diagnosis; requiring that certain health maintenance contracts issued or renewed on or after a specified date provide specified minimum coverage for breast cancer screening and diagnosis, etc.
Plain English Summary
AI-GENERATEDFour mammogram-coverage statutes -- for individual policies, group and franchise policies, small-employer health plans, and HMO contracts -- move to the same new schedule: a covered mammogram every year starting at age 40, replacing today's single baseline exam at 35 and every-other-year testing from 40 to 49.
Insurers and HMOs must also cover one additional supplemental scan a year -- MRI, ultrasound, contrast-enhanced mammography, or molecular breast imaging -- for any woman a physician identifies as being at increased risk of developing breast cancer, using criteria the bill spells out for the first time.
That increased-risk coverage extends to a woman whose only finding is dense breast tissue, with no lump or other abnormality present, and continues through a cancer survivor's post-treatment monitoring period, before a doctor declares her cured or in long-term remission.
These requirements apply to policies and contracts issued or renewed on or after January 1, 2027, not to coverage already in force.
AIThe bill replaces the old three-tier schedule -- one baseline exam at 35-39, a mammogram every two years at 40-49, annual at 50+ -- with a single rule: every woman 40 or older is guaranteed a covered mammogram every year. Women 35-39 lose the guaranteed baseline exam unless they separately qualify as increased risk.
AIFor the first time, insurers and HMOs must cover one additional supplemental scan a year -- MRI, ultrasound, contrast-enhanced mammography, or molecular breast imaging -- for any woman a physician identifies as being at increased risk of developing breast cancer.
AIA woman whose only finding is dense breast tissue, with no lump or other abnormality, still counts as increased risk, so her policy must cover the extra annual mammogram and supplemental scan, not just a standard screening mammogram.
AIOnce treatment for breast cancer ends, coverage for the mandated mammograms and supplemental screening keeps applying through the remission and surveillance period that follows, up until a doctor formally declares the patient cured or in long-term remission.
AIThe individual-policy statute used to exclude only disability income, specified disease, and hospital indemnity policies from the mammogram mandate, implicitly covering everything else. The rewrite instead limits the mandate affirmatively to policies providing major medical or similar comprehensive coverage.