Bill > S1500

This bill aims to require group health plans and health insurance providers to cover diagnostic and supplemental breast examinations without imposing any cost-sharing requirements, such as deductibles, copayments, or coinsurance. The bill defines diagnostic breast examinations as medically necessary tests (like mammography, MRI, or ultrasound) used to evaluate abnormalities detected during screening or through other means, and supplemental breast examinations as additional screenings based on personal or family medical history that may indicate an increased risk of breast cancer. These examinations must align with National Comprehensive Cancer Network Guidelines. The bill allows health plans to still require prior authorization and maintain appropriate utilization controls. It also preserves states' abilities to provide even stronger protections for breast examination coverage. The legislation will apply to both new and grandfathered health plans, and it includes a provision ensuring that high-deductible health plans with health savings accounts can cover these examinations without losing their tax-advantaged status. The changes will take effect for plan years beginning on or after January 1, 2026, ultimately making breast cancer diagnostic and supplemental examinations more accessible by removing financial barriers to these critical screenings.

Health and Social Services

https://www.congress.gov/bill/119th-congress/senate-bill/1500/all-info