Plain English Breakdown
The source text mentions exceptions ('except as specified') but does not list what those specific exceptions are.
Health Care Coverage: Diagnostic Imaging
Starting in January 2028, new or renewed health plans must cover screening mammography and certain diagnostic breast imaging tests without charging patients extra fees.
What This Bill Does
- Requires specific health plan contracts issued, amended, or renewed on or after January 1, 2028, to provide coverage for screening mammography without cost sharing.
- Requires these plans to cover medically necessary diagnostic breast imaging without cost sharing.
- Includes coverage for diagnostic imaging following an abnormal mammogram result.
- Includes coverage for diagnostic imaging for people identified as having a risk factor associated with breast cancer.
Who It Names or Affects
- Health care service plan contracts regulated by the Department of Managed Health Care.
- Policies of health insurance that provide hospital, medical, or surgical coverage regulated by the Department of Insurance.
- Self-insured employee welfare benefit plans.
- Enrollees and insured individuals who need screening mammography or diagnostic breast imaging.
Terms To Know
- Cost sharing
- Fees that patients pay for health care services, such as copayments, coinsurance, or deductibles.
- Screening mammography
- A breast imaging test used to check for cancer in people who do not have symptoms.
- Diagnostic breast imaging
- Breast imaging tests performed when a patient has symptoms, an abnormal result from a screening test, or is identified as having a risk factor associated with breast cancer.
Limits and Unknowns
- The law only applies to plans issued, amended, or renewed on or after January 1, 2028.
- Coverage requirements include exceptions 'as specified' in the bill text, though specific details of those exceptions are not listed here.