376.1183. Breast examinations, no cost-sharing requirements.

383 words·~2 min read·/mo/chapter-376/376-1183

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376.1183. Breast examinations, no cost-sharing requirements. — 1. For purposes of this section, the following terms mean:

(1)"Cost-sharing requirement" , any deductible, coinsurance, co-payment, or maximum limitation on the application of such deductible, coinsurance, co-payment, or similar out-of-pocket expense;

(2)"Diagnostic breast examination" , any medically necessary and appropriate examination of the breast, including such an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is:

(a)Used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or

(b)Used to evaluate an abnormality detected by another means of examination;

(3)"Health benefit plan" , the same meaning given to the term in section 376.1350 ;

(4)"Health carrier" , the same meaning given to the term in section 376.1350 ;

(5)"Supplemental breast examination" , any medically necessary and appropriate examination of the breast, including such an examination using breast magnetic resonance imaging or breast ultrasound, that is:

(a)Used to screen for breast cancer when there is no abnormality seen or suspected; and

(b)Based on personal or family medical history or any additional factors that may increase the patient's risk of breast cancer.

2. Each health carrier or health benefit plan that offers or issues health benefit plans that are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2024, and that provide coverage for diagnostic breast examinations, coverage for supplemental breast examinations, coverage required under section 376.782 , or any combination of such coverages shall not impose any cost-sharing requirements with respect to any such coverage.

3. If, under federal law, application of the requirement under subsection 2 of this section would result in health savings account ineligibility under Section 223 of the Internal Revenue Code, the requirement under subsection 2 of this section shall apply to health savings account-qualified high deductible health plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under Section 223 , except with respect to items or services that are preventive care under Section 223(c)(2)(C) of the Internal Revenue Code, in which case the requirement of subsection 2 of this section shall apply regardless of whether the minimum deductible under Section 223 has been satisfied.

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(L. 2023 S.B. 106)