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REFERENCE TITLE: insurance; breast screenings; cost sharing.. |
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State of Arizona House of Representatives Fifty-sixth Legislature First Regular Session 2023
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HB 2684 |
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Introduced by Representatives Hernandez A: Hernandez C, Hernandez L, Seaman, Travers
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An Act
amending title 20, chapter 4, article 3, Arizona Revised Statutes, by adding section 20-841.14; amending title 20, chapter 4, article 9, Arizona Revised Statutes, by adding section 20-1057.20; amending title 20, chapter 6, article 4, Arizona Revised Statutes, by adding section 20-1376.11; amending title 20, chapter 6, article 5, Arizona Revised Statutes, by adding section 20-1406.11; relating to health insurance.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 20, chapter 4, article 3, Arizona Revised Statutes, is amended by adding section 20-841.13, to read:
20-841.14. Breast health examinations; cost sharing prohibition; definitions
A. Beginning january 1, 2025, a hospital service corporation or a medical service corporation that issues, amends, delivers or renews subscription contracts that provide breast health examinations, including screenings, diagnostic breast examinations and supplemental breast examinations, may not impose a cost sharing requirement on a subscriber.
B. For the purposes of this section:
2. "Diagnostic breast examination" means a breast examination that is medically necessary and clinically appropriate, that includes diagnostic mammography, breast magnetic resonance imaging or breast ultrasound and that is used to evaluate:
(a) an abnormality that is seen or suspected as a result of a breast screening.
(b) an abnormality that is detected by any other means of examination.
3. "Supplemental breast examination" means a breast examination that is medically necessary and clinically appropriate, that includes diagnostic mammography, breast magnetic resonance imaging or breast ultrasound and that is:
(a) Used to screen for breast cancer when there is no seen or suspected abnormality.
(b) Based on personal or family medical history or additional factors that may increase an individual's risk of breast cancer.
Sec. 2. Title 20, chapter 4, article 9, Arizona Revised Statutes, is amended by adding section 20-1057.20, to read:
20-1057.20. Breast health examinations; cost sharing prohibition; definitions
A. Beginning January 1, 2025, A health care services organization that issues, amends, delivers or renews EVIDENCEs of coverage that provide breast health examinations, including screenings, diagnostic breast examinations and supplemental breast examinations, may not impose a cost sharing requirement on an enrollee.
B. For the purposes of this section:
1. "Cost sharing requirement" means a requirement to pay any deductible, coinsurance, copayment, out-of-pocket maximum or similar out-of-pocket expense.
2. "Diagnostic breast examination" means a breast examination that is medically necessary and clinically appropriate, that includes diagnostic mammography, breast magnetic resonance imaging or breast ultrasound and that is used to evaluate:
(a) an abnormality that is seen or suspected as a result of a breast screening.
(b) an abnormality that is detected by any other means of examination.
3. "Supplemental breast examination" means a breast examination that is medically necessary and clinically appropriate, that includes diagnostic mammography, breast magnetic resonance imaging or breast ultrasound and that is:
(a) Used to screen for breast cancer when there is no seen or suspected abnormality.
(b) Based on personal or family medical history or additional factors that may increase an individual's risk of breast cancer.
Sec. 3. Title 20, chapter 6, article 4, Arizona Revised Statutes, is amended by adding section 20-1376.11, to read:
20-1376.11. Breast health examinations; cost sharing prohibition; definitions
A. Beginning January 1, 2025, a disability insurer that issues, amends, delivers or renews policies that provide breast health examinations, including screenings, diagnostic breast examinations and supplemental breast examinations, may not impose a cost sharing requirement on an insured.
B. For the purposes of this section:
1. "Cost sharing requirement" means a requirement to pay any deductible, coinsurance, copayment, out-of-pocket maximum or similar out-of-pocket expense.
2. "Diagnostic breast examination" means a breast examination that is medically necessary and clinically appropriate, that includes diagnostic mammography, breast magnetic resonance imaging or breast ultrasound and that is used to evaluate:
(a) an abnormality that is seen or suspected as a result of a breast screening.
(b) an abnormality that is detected by any other means of examination.
3. disability insurer does not include limited benefit coverage as defined in section 20-1137.
4. "Supplemental breast examination" means a breast examination that is medically necessary and clinically appropriate, that includes diagnostic mammography, breast magnetic resonance imaging or breast ultrasound and that is:
(a) Used to screen for breast cancer when there is no seen or suspected abnormality.
(b) Based on personal or family medical history or additional factors that may increase an individual's risk of breast cancer.
Sec. 4. Title 20, chapter 6, article 5, Arizona Revised Statutes, is amended by adding section 20-1406.11, to read:
20-1406.11. Breast health examinations; cost sharing prohibition; definitions
A. Beginning January 1, 2025, a group or blanket disability insurer that issues, amends, delivers or renews policies that provide breast health examinations, including screenings, diagnostic breast examinations and supplemental breast examinations, may not impose a cost sharing requirement on an insured.
B. For the purposes of this section:
1. "Cost sharing requirement" means a requirement to pay any deductible, coinsurance, copayment, out-of-pocket maximum or similar out-of-pocket expense.
2. "Diagnostic breast examination" means a breast examination that is medically necessary and clinically appropriate, that includes diagnostic mammography, breast magnetic resonance imaging or breast ultrasound and that is used to evaluate:
(a) an abnormality that is seen or suspected as a result of a breast screening.
(b) an abnormality that is detected by any other means of examination.
3. Group or blanket disability insurer does not include limited benefit coverage as defined in section 20-1137.
4. "Supplemental breast examination" means a breast examination that is medically necessary and clinically appropriate, that includes diagnostic mammography, breast magnetic resonance imaging or breast ultrasound and that is:
(a) Used to screen for breast cancer when there is no seen or suspected abnormality.
(b) Based on personal or family medical history or additional factors that may increase an individual's risk of breast cancer.