SB 413

This bill requires health insurance policies to cover, either fully or with a

maximum out-of-pocket cost of $50, essential breast screenings beyond

mammography in individuals who have had mammograms showing dense breast

tissue, women who are at higher risk for cancer, or women whose health care

provider considers the screenings to be medically necessary for any woman who is

considered by the health care provider to have an above-average risk for breast

cancer in accordance with certain guidelines. Health insurance policies are referred

to in the statutes as disability insurance policies. Self-insured governmental health

plans are also required to provide the coverage specified in the bill. The bill also

requires coverage of those essential breast screenings by the Medical Assistance

program, which is the state-administered Medicaid program that is jointly-funded

by the state and federal governments and that provides health services to

individuals with limited financial resources.

Health insurance policies are required under current law to cover two

mammographic breast examinations to screen for breast cancer for a woman from

age 45 to 49 if certain criteria are satisfied. Health insurance policies must currently

cover annual mammograms for a woman once she attains the age of 50. The coverage

required under current law is required whether or not the woman shows any

symptoms of breast cancer and may be subject to only the same exclusions and

limitations, including cost sharing, that apply to other radiological examinations

under the policy. The bill does not change or eliminate the current coverage

requirements for mammograms except that preferred provider plans are explicitly

included in the current law and the bill's requirements.

This proposal may contain a health insurance mandate requiring a social and

financial impact report under s. 601.423, stats.