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SB1165 - 572R - S Ver
Senate Engrossed
insurance; cost
sharing; breast exams
State of Arizona
Senate
Fifty-seventh Legislature
Second Regular Session
2026
SENATE BILL 1165
AN
ACT
amending title 20, chapter 4, article 3,
Arizona Revised Statutes, by adding section 20-841.14; amending title 20,
chapter 4, article 9, Arizona Revised Statutes, by adding section 20-1057.21;
amending title 20, chapter 6, article 4, Arizona Revised Statutes, by adding
section 20-1376.11; amending title 20, chapter 6, article 5, Arizona
Revised Statutes, by adding section 20-1406.11; relating to health
insurance.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it
enacted by the Legislature of the State of Arizona:
Section 1. Title 20, chapter 4, article 3,
Arizona Revised Statutes, is amended by adding section 20-841.14, to read:
START_STATUTE
20-841.14.
Breast examinations; cost sharing; exception; definitions
A. a hospital service corporation or
medical service corporation that issues, amends, delivers or renews a
subscription contract On or after January 1, 2027 may not impose cost sharing
requirements for
PREVENTATIVE SCREENING SERVICES FOR
BREAST CANCER OR FOR ADDITIONAL SCREENING SERVICES REQUIRED TO COMPLETE THE
SCREENING CONTINUUM.�
b. If a subscription contract
includes a high deductible health plan as defined in 26 United States Code
section 223(
c
)(2)(a), subsection A of this section
applies after the deductible is met, except that if the items or services are
preventive as prescribed in 26 United States Code section 223(
c
)(2)(C), subsection A of this section applies regardless of whether
the minimum deductible under 26 United States Code section 223 has been met.
C. For the purposes of this section:
1. "aDDITIONAL SCREENING
SERVICES" INCLUDES A DIAGNOSTIC BREAST EXAMINATION AND A SUPPLEMENTAL
BREAST EXAMINATION.
2. "Cost sharing" means a
deductible, coinsurance, copayment or maximum limitation on the application of
the deductible, coinsurance, copayment or similar out-of-pocket
expense.
3. "Diagnostic Breast
Examination":
(
a
) Means a
medically necessary and appropriate examination of the breast in accordance
with the National Comprehensive Cancer Network Guidelines.
(
b
) Includes an
examination of the breast using contrast enhanced mammography, diagnostic
mammography, breast magnetic resonance imaging or breast ultrasound or
molecular breast imaging that is used to either:
(
i
) Evaluate an
abnormality that is seen or suspected from a screening examination for breast
cancer.
(
ii
) Evaluate
an abnormality that is detected by another means of examination.
4. "pREVENTATIVE SCREENING
SERVICE FOR BREAST CANCER" MEANS SCREENING MAMMOGRAPHY AS DEFINED IN
SECTION 30-651.
5. "Supplemental breast
examination":
(
a
) means a
medically necessary and appropriate examination of the breast in accordance
with the National Comprehensive Cancer Network guidelines.
(
b
) Includes an
examination of the breast using contrast enhanced mammography, breast magnetic
resonance imaging or breast ultrasound or molecular breast imaging that is
both:
(
i
) Used to
screen for breast cancer when there is no abnormality seen or suspected.
(
ii
) Based on a
personal or family medical history or additional factors that increase an
individual's risk of breast cancer, including heterogenous or extremely dense
breasts.
END_STATUTE
Sec. 2. Title
20, chapter 4, article 9, Arizona Revised Statutes, is amended by adding
section 20-1057.21, to read:
START_STATUTE
20-1057.21.
Breast examinations; cost sharing; exception; definitions
A. a health care services
organization that issues, amends, delivers or renews an evidence of coverage On
or after January 1, 2027 may not impose cost sharing requirements for
PREVENTATIVE SCREENING SERVICES FOR BREAST CANCER OR FOR ADDITIONAL
SCREENING SERVICES REQUIRED TO COMPLETE THE SCREENING CONTINUUM.
B. If an evidence of coverage
includes a high deductible health plan as defined in 26 United States Code
section 223(
c
)(2)(a), subsection A of this section
applies after the deductible is met, except that if the items or services are
preventive as prescribed in 26 United States Code section 223(
c
)(2)(C), subsection A of this section applies regardless of whether
the minimum deductible under 26 United States Code section 223 has been met.
c. For the purposes of this section:
1. "additional screening
services" includes a diagnostic breast examination and a supplemental
breast examination.
2. "Cost sharing" means a
deductible, coinsurance, copayment or maximum limitation on the application of
the deductible, coinsurance, copayment or similar out-of-pocket
expense.
3. "Diagnostic Breast
Examination":
(
a
) Means a
medically necessary and appropriate examination of the breast in accordance
with the National Comprehensive Cancer Network Guidelines.
(
b
) Includes an
examination of the breast using contrast enhanced mammography, diagnostic
mammography, breast magnetic resonance imaging or breast ultrasound or
molecular breast imaging that is used to either:
(
i
) Evaluate an
abnormality that is seen or suspected from a screening examination for breast
cancer.
(
ii
) Evaluate
an abnormality that is detected by another means of examination.
4. "preventative screening services for
breast cancer" means screening mammography as defined in section 30-651.
5. "Supplemental breast
examination":
(
a
) means a
medically necessary and appropriate examination of the breast in accordance
with the National Comprehensive Cancer Network guidelines.
(
b
) Includes an
examination of the breast using contrast enhanced mammography, breast magnetic
resonance imaging or breast ultrasound or molecular breast imaging that is
both:
(
i
) Used to
screen for breast cancer when there is no abnormality seen or suspected.
(
ii
) Based on a
personal or family medical history or additional factors that increase an
individual's risk of breast cancer, including heterogenous or extremely dense
breasts.
END_STATUTE
Sec. 3. Title
20, chapter 6, article 4, Arizona Revised Statutes, is amended by adding
section 20-1376.11, to read:
START_STATUTE
20-1376.11.
Breast examinations; cost sharing; exception; definitions
A. a disability insurer that issues,
amends, delivers or renews a policy On or after January 1, 2027 may not impose
cost sharing requirements for
preventative screening
services for breast cancer or for additional screening services required to
complete the screening continuum.
b. If a policy includes a high
deductible health plan as defined in 26 United States Code section 223(
c
)(2)(a), subsection A of this section applies after the deductible is
met, except that if the items or services are preventive as prescribed in 26
United States Code section 223(
c
)(2)(C), subsection A of
this section applies regardless of whether the minimum deductible under 26
United States Code section 223 has been met.
c. For
the purposes of this section:
1. "additional
screening services" includes a diagnostic breast examination and a
supplemental breast examination.
2. "Cost
sharing" means a deductible, coinsurance, copayment or maximum limitation
on the application of the deductible, coinsurance, copayment or similar out-of-pocket
expense.
3. "Diagnostic Breast
Examination":
(
a
) Means a
medically necessary and appropriate examination of the breast in accordance
with the National Comprehensive Cancer Network Guidelines.
(
b
) Includes an
examination of the breast using contrast enhanced mammography, diagnostic
mammography, breast magnetic resonance imaging or breast ultrasound or
molecular breast imaging that is used to either:
(
i
) Evaluate an
abnormality that is seen or suspected from a screening examination for breast
cancer.
(
ii
) Evaluate
an abnormality that is detected by another means of examination.
4. "preventative screening
services for breast cancer" means screening mammography as defined in
section 30-651.
5. "Supplemental breast
examination":
(
a
) means a
medically necessary and appropriate examination of the breast in accordance
with the National Comprehensive Cancer Network guidelines.
(
b
) Includes an
examination of the breast using contrast enhanced mammography, breast magnetic
resonance imaging or breast ultrasound or molecular breast imaging that is
both:
(
i
) Used to
screen for breast cancer when there is no abnormality seen or suspected.
(
ii
) Based on a
personal or family medical history or additional factors that increase an
individual's risk of breast cancer, including heterogenous or extremely dense
breasts.
END_STATUTE
Sec. 4. Title
20, chapter 6, article 5, Arizona Revised Statutes, is amended by adding
section 20-1406.11, to read:
START_STATUTE
20-1406.11.
Breast examinations; cost sharing; exception; definitions
A. a group or blanket disability
insurer that issues, amends, delivers or renews a policy On or after January 1,
2027 may not impose cost sharing requirements for
preventative
screening services for breast cancer or for additional screening services
required to complete screening continuum.
b. If a policy includes a high
deductible health plan as defined in 26 United States Code section 223(
c
)(2)(a), subsection A of this section applies after the deductible is
met, except that if the items or services are preventive as prescribed in 26
United States Code section 223(
c
)(2)(C), subsection A of
this section applies regardless of whether the minimum deductible under 26
United States Code section 223 has been met.
c. For the purposes of this section:
1. "additional screening
services" includes a diagnostic breast examination and a supplemental
breast examination.
2. "Cost sharing" means a
deductible, coinsurance, copayment or maximum limitation on the application of
the deductible, coinsurance, copayment or similar out-of-pocket
expense.
3. "Diagnostic
Breast Examination":
(
a
) Means a medically necessary and appropriate examination
of the breast in accordance with the National Comprehensive Cancer Network
Guidelines.
(
b
) Includes an
examination of the breast using contrast enhanced mammography, diagnostic
mammography, breast magnetic resonance imaging or breast ultrasound or
molecular breast imaging that is used to either:
(
i
) Evaluate an
abnormality that is seen or suspected from a screening examination for breast
cancer.
(
ii
) Evaluate
an abnormality that is detected by another means of examination.
4. "preventative screening
services for breast cancer" means screening mammography as defined in
section 30-651.
5. "Supplemental
breast examination":
(
a
) means a medically necessary and appropriate examination
of the breast in accordance with the National Comprehensive Cancer Network
guidelines.
(
b
) Includes an
examination of the breast using contrast enhanced mammography, breast magnetic
resonance imaging or breast ultrasound or molecular breast imaging that is both
of the following:
(
i
) Used to
screen for breast cancer when there is no abnormality seen or suspected.
(
ii
) Based on a
personal or family medical history or additional factors that increase an
individual's risk of breast cancer, including heterogenous or extremely dense
breasts.
END_STATUTE