AB 117

This bill requires health insurance policies to provide coverage for

supplemental breast screening examinations or diagnostic breast examinations for

an individual who is at increased risk of breast cancer, as determined in accordance

with the most recent applicable guidelines of the National Comprehensive Cancer

Network, or has heterogeneously or extremely dense breast tissue, as defined by the

Breast Imaging-Reporting and Data System established by the American College of

Radiology. 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

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.

Under the bill, health insurance policies may not charge a cost-sharing amount

for a supplemental breast screening examination or diagnostic breast examination.

The limitation on cost-sharing does not apply to the extent that the limitation would

result in ineligibility for a health savings account under the federal Internal Revenue

Code.

Health insurance policies are required under current law to cover two

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

ages 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.