Bill > H297

This bill aims to improve health insurance coverage for breast cancer screening and diagnostic imaging by establishing comprehensive requirements for health benefit plans in North Carolina. The legislation defines various types of breast imaging services, including mammograms, breast ultrasounds, and magnetic resonance imaging (MRI), and mandates that insurers provide coverage for diagnostic, screening, and supplemental breast cancer examinations with cost-sharing requirements no less favorable than those for standard screening mammography. The bill provides detailed definitions for different types of breast examinations, specifying when and how often women can receive these services based on age and risk factors, such as personal or family medical history. Additionally, the bill regulates healthcare provider billing practices by requiring providers who are not in an insurer's network to accept the insurer's reimbursement rate for breast cancer prevention services and prohibiting them from billing patients for amounts beyond that rate. The provisions will become effective on October 1, 2025, and will apply to insurance contracts and healthcare services issued, renewed, or provided on or after that date, with the goal of increasing access to and affordability of comprehensive breast cancer screening and diagnostic services.

Business and Industry, Government Affairs, Health and Social Services

https://www.ncleg.gov/BillLookUp/2025/H297