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REFERENCE TITLE: insurance; cost sharing; breast examinations |
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State of Arizona House of Representatives Fifty-sixth Legislature Second Regular Session 2024
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HB 2411 |
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Introduced by Representatives Cook: Bliss, Carbone, Hernandez A, Willoughby
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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 20-841.14, to read:
20-841.14. Breast examinations; cost sharing; high deductible health plan; exception; definitions
A. a hospital service corporation or medical service corporation that issues, amends, delivers or renews a subscription contract On or after January 1, 2025 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations.
b. A hospital service corporation or medical service corporation that provides a subscription contract to a subscriber that is intended to qualify as a high deductible health plan as defined in 26 United States Code section 223(c)(2) may impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations and for items or services that are classified as preventive care until the minimum deductible is met.
c. For the purposes of this section:
1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense.
2. "Diagnostic Breast Examination":
(a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines.
(b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either:
(i) Seen or suspected from a screening examination for breast cancer.
(ii) Detected by another means of examination.
3. "Supplemental breast examination":
(a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines.
(b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following:
(i) Used to screen for breast cancer when there is no abnormality seen or suspected.
(ii) Based on a personal or family medical history.
(iii) Based on 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 examinations; cost sharing; high deductible health plan; exception; definitions
A. a health care services organization that issues, amends, delivers or renews an evidence of coverage On or after January 1, 2025 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations.
b. A health care services organization that provides an evidence of coverage to an enrollee that is intended to qualify as a high deductible health plan as defined in 26 United States Code section 223(c)(2) may impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations and for items or services that are classified as preventive care until the minimum deductible is met.
c. For the purposes of this section:
1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense.
2. "Diagnostic Breast Examination":
(a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines.
(b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either:
(i) Seen or suspected from a screening examination for breast cancer.
(ii) Detected by another means of examination.
3. "Supplemental breast examination":
(a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines.
(b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following:
(i) Used to screen for breast cancer when there is no abnormality seen or suspected.
(ii) Based on a personal or family medical history.
(iii) Based on 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 examinations; cost sharing; high deductible health plan; exception; definitions
A. a disability insurer that issues, amends, delivers or renews a policy On or after January 1, 2025 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations.
b. A disability insurer that provides a policy to an insured that is intended to qualify as a high deductible health plan as defined in 26 United States Code section 223(c)(2) may impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations and for items or services that are classified as preventive care until the minimum deductible is met.
c. For the purposes of this section:
1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense.
2. "Diagnostic Breast Examination":
(a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines.
(b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either:
(i) Seen or suspected from a screening examination for breast cancer.
(ii) Detected by another means of examination.
3. "Supplemental breast examination":
(a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines.
(b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following:
(i) Used to screen for breast cancer when there is no abnormality seen or suspected.
(ii) Based on a personal or family medical history.
(iii) Based on 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 examinations; cost sharing; high deductible health plan; exception; definitions
A. a group or blanket disability insurer that issues, amends, delivers or renews a policy On or after January 1, 2025 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations.
b. A group or blanket disability insurer that provides a policy to an insured that is intended to qualify as a high deductible health plan as defined in 26 United States Code section 223(c)(2) may impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations and for items or services that are classified as preventive care until the minimum deductible is met.
c. For the purposes of this section:
1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense.
2. "Diagnostic Breast Examination":
(a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines.
(b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either:
(i) Seen or suspected from a screening examination for breast cancer.
(ii) Detected by another means of examination.
3. "Supplemental breast examination":
(a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines.
(b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following:
(i) Used to screen for breast cancer when there is no abnormality seen or suspected.
(ii) Based on a personal or family medical history.
(iii) Based on additional factors that may increase an individual's risk of breast cancer.