Bill > SB264

Introduced Session

This bill requires health insurance policies to provide coverage for diagnostic breast examinations and for supplemental breast screening 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 LRB-3021/1 JPC&SWB:cdc 2025 - 2026 Legislature SENATE BILL 264 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. For further information see the state fiscal estimate, which will be printed as an appendix to this bill.

Committee Categories

Rachael Cabral-Guevara (R)*,  Tim Carpenter (D)*,  Kristin Dassler-Alfheim (D)*,  Dora Drake (D)*,  Jodi Habush Sinykin (D)*,  Dianne Hesselbein (D)*,  Jesse James (R)*,  LaTonya Johnson (D)*,  Sarah Keyeski (D)*,  Chris Larson (D)*,  Steve Nass (R)*,  Melissa Ratcliff (D)*,  Kelda Roys (D)*,  Mark Spreitzer (D)*,  Jamie Wall (D)*,  Clint Anderson (D),  Deb Andraca (D),  Margaret Arney (D),  Mike Bare (D),  Elijah Behnke (R),  Brienne Brown (D),  Ryan Clancy (D),  Karen DeSanto (D),  Ben DeSmidt (D),  Barbara Dittrich (R),  Robert Donovan (R),  Cindi Duchow (R),  Joan Fitzgerald (D),  Benjamin Franklin (R),  Joy Goeben (R),  Rick Gundrum (R),  Nate Gustafson (R),  Andrew Hysell (D),  Alex Joers (D),  Tara Johnson (D),  Karen Kirsch (D),  Rob Kreibich (R),  Dave Maxey (R),  Vincent Miresse (D),  Supreme Moore Omokunde (D),  Jeff Mursau (R),  Amanda Nedweski (R),  Greta Neubauer (D),  Adam Neylon (R),  Jerry O'Connor (R),  Sylvia Ortiz-Velez (D),  Lori Palmeri (D),  Pricilla Prado (D),  Joe Sheehan (D),  Lee Snodgrass (D),  Ryan Spaude (D),  David Steffen (R),  Angela Stroud (D),  Shelia Stubbs (D),  Lisa Subeck (D),  Ron Tusler (R),  Randy Udell (D),  Robyn Vining (D), 

Representative Rivera-Wagner added as a cosponsor (on 07/02/2025)

Official Document