Bill > HR3037

This bill, known as the "Access to Breast Cancer Diagnosis Act of 2025", requires group health plans and health insurance issuers to cover diagnostic and supplemental breast examinations without imposing any cost-sharing requirements like deductibles, copayments, or coinsurance. Diagnostic breast examinations are defined as medically necessary tests (such as mammography, MRI, or ultrasound) used to evaluate abnormalities detected during screening or by other means, while supplemental breast examinations are screenings based on personal or family medical history that may indicate higher breast cancer risk. The bill ensures that these examinations will be covered without out-of-pocket costs for patients, starting with plan years beginning on or after January 1, 2026. The legislation allows health plans to still require prior authorization and maintain appropriate utilization controls, and does not prevent states from implementing even more protective coverage requirements. Additionally, the bill includes provisions to apply these requirements to grandfathered health plans and high-deductible health plans with health savings accounts, ensuring broad implementation across different types of health insurance plans.

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https://www.congress.gov/bill/119th-congress/house-bill/3037/all-info