2019 -- H 6005

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LC002425

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Fogarty, Carson, Caldwell, Cortvriend, and Messier

     Date Introduced: April 12, 2019

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-18-41 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

     27-18-41. Mammograms and pap smears -- Coverage mandated.

     (a) (1) Every individual or group hospital or medical expense insurance policy or

individual or group hospital or medical services plan contract delivered, issued for delivery, or

renewed in this state shall provide coverage for mammograms and pap smears, in accordance

with guidelines established by the American Cancer Society.

     (2) Notwithstanding the provisions of this chapter, every individual or group hospital or

medical insurance policy or individual or group hospital or medical services plan contract

delivered, issued for delivery, or renewed in this state shall pay for two (2) screening

mammograms per year when recommended by a physician for women who have been treated for

breast cancer within the last five (5) years or are at high risk of developing breast cancer due to

genetic predisposition (BRCA gene mutation or multiple first degree relatives) or high risk lesion

on prior biopsy (lobular carcinoma in situ) or atypical ductal hyperplasia and for any person who

has received notice pursuant to § 23-12.9-2 of the existence of dense breast tissue, coverage shall

be provided for the costs of breast ultrasound screenings, breast MRI exams and/or digital breast

tomosynthesis (dbt) screenings.

     (b) This section shall not apply to insurance coverage providing benefits for: (1) hospital

confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare

supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily

injury or death by accident or both; and (9) other limited benefit policies.

     SECTION 2. Section 27-19-20 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

     27-19-20. Mammograms and pap smears -- Coverage mandated.

     (a) Subscribers to any nonprofit hospital service plan shall be afforded coverage under

the plan for mammograms and pap smears, in accordance with guidelines established by the

American Cancer Society.

     (b) Notwithstanding the provisions of this chapter, subscribers to any nonprofit hospital

service plan shall be afforded coverage for two (2) screening mammograms per year when

recommended by a physician for women who have been treated for breast cancer within the last

five (5) years or who are at high risk of developing breast cancer due to genetic predisposition

(BRCA gene mutation or multiple first degree relatives) or high risk lesion on prior biopsy

(lobular carcinoma in situ) or atypical ductal hyperplasia and for any person who has received

notice pursuant to § 23-12.9-2 of the existence of dense breast tissue, coverage shall be provided

for the costs of breast ultrasound screenings, breast MRI exams and/or digital breast

tomosynthesis (dbt) screenings.

     SECTION 3. Section 27-20-17 of the General Laws in Chapter 27-20 entitled "Nonprofit

Medical Service Corporations" is hereby amended to read as follows:

     27-20-17. Mammograms and pap smears -- Coverage mandated.

     (a) Subscribers to any nonprofit medical service plan shall be afforded coverage under

the plan for mammograms and pap smears, in accordance with guidelines established by the

American Cancer Society.

     (b) Notwithstanding the provisions of this chapter, subscribers to any nonprofit medical

service plan shall be afforded coverage for two (2) paid screening mammograms per year when

recommended by a physician for women who have been treated for breast cancer within the last

five (5) years or who are at high risk of developing breast cancer due to genetic predisposition

(BRCA gene mutation or multiple first degree relatives) or high risk lesion on prior biopsy

(lobular carcinoma in situ) or atypical ductal hyperplasia and for any person who has received

notice pursuant to § 23-12.9-2 of the existence of dense breast tissue, coverage shall be provided

for the costs of breast ultrasound screenings, breast MRI exams and/or digital breast

tomosynthesis (dbt) screenings.

     SECTION 4. Section 27-41-30 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

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     27-41-30. Mammograms and pap smears -- Coverage mandated.

     (a) Subscribers to any health maintenance organization plan shall be afforded coverage

under that plan for mammograms and pap smears, in accordance with guidelines established by

the American Cancer Society.

     (b) Notwithstanding the provisions of this chapter, subscribers to any health maintenance

organization plan shall be afforded coverage for two (2) paid screening mammograms per year

when recommended by a physician for women who have been treated for breast cancer within the

last five (5) years or who are at high risk of developing breast cancer due to genetic

predisposition (BRCA gene mutation or multiple first degree relatives) or high risk lesion on prior

biopsy (lobular carcinoma in situ) or atypical ductal hyperplasia and for any person who has

received notice pursuant to § 23-12.9-2 of the existence of dense breast tissue, coverage shall be

provided for the costs of breast ultrasound screenings, breast MRI exams and/or digital breast

tomosynthesis (dbt) screenings.

     SECTION 5. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

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     This act would require insurance carriers, nonprofit hospital service plans, nonprofit

medical service corporations and health maintenance organizations to cover the costs of breast

ultrasounds and/or MRI breast exams for any person receiving notice of dense breast tissue

pursuant to § 23-12.9-2.

     This act would take effect upon passage.

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