Health benefit plans covered by this section may not charge enrollees any cost-sharing for supplemental or diagnostic breast examinations.
(a) For purposes of this section, the following terms have the following meanings: (1) COST-SHARING REQUIREMENT. A deductible, copayment, coinsurance, or similar expense borne by the insured for a covered benefit under a health benefit plan. (2) DIAGNOSTIC BREAST EXAMINATION. A medically necessary and appropriate examination of the breast that includes, but is not limited to, contrast-enhanced mammography, diagnostic mammography, breast magnetic resonance imaging, breast ultrasound, or molecular breast imaging which is used to: a. Evaluate an abnormality seen or suspected from a screening examination for breast cancer; or b. Evaluate an abnormality detected by another means of examination. (3) HEALTH BENEFIT PLAN. a. Any plan, policy, or contract issued, delivered, or renewed in this state which provides health coverage that includes payment for hospitalization, physician care, treatment, surgery, therapy, drugs, equipment, and any other medical expense, regardless of the following: 1. Whether the plan, policy, or contract is provided by a health care insurer; health maintenance organization established under Chapter 21A of Title 27; health care services plan established under Chapter 20 of Title 10A; a nonprofit agricultural organization that provides health benefits to its members under Chapter 33 of Title 2; or any other entity that pays for, purchases, or reimburses for health care services. 2. Whether the plan is for a group or an individual. b. The term does not include accident-only, specified disease, individual hospital indemnity, credit, dental-only, Medicare supplement, long-term care, disability income, or other limited benefit health insurance policies, or coverage issued as supplemental to liability insurance, workers’ compensation, or automobile medical payment insurance. (4) SUPPLEMENTAL BREAST EXAMINATION. A medically necessary and appropriate examination of the breast which includes, but is not limited to, contrast-enhanced mammography, breast magnetic resonance imaging, breast ultrasound, or molecular breast imaging that is used to screen for breast cancer when there is no abnormality seen or suspected, based on personal or family medical history or additional factors that increase the risk of breast cancer, including dense tissue, on the recommendation of a physician. (b) A health benefit plan that pays for, purchases, or furnishes health care services to individuals who reside in this state, and which provides coverage for a supplemental breast examination or a diagnostic breast examination, may not impose any cost-sharing requirement on an enrollee for a supplemental breast examination or diagnostic breast examination.