Health care coverage: diagnostic imaging.

Plain English Breakdown

The official source material does not specify any additional limits or unknowns beyond those already listed in the candidate explanation.

Health Care Coverage: Diagnostic Imaging

The bill requires health insurance plans to cover screening mammograms and medically necessary diagnostic breast imaging without cost sharing starting January 1, 2028.

What This Bill Does

• Requires health care service plan contracts, policies of health insurance that provide hospital, medical, or surgical coverage, health insurance policies, and self-insured employee welfare benefit plans to cover screening mammograms without cost sharing.
• Requires these same plans to cover medically necessary diagnostic breast imaging following an abnormal mammogram result without cost sharing.
• Also requires these plans to cover medically necessary diagnostic breast imaging for people with risk factors associated with breast cancer without cost sharing.

Who It Names or Affects

• People who have health insurance that covers hospital, medical, or surgical care.
• Self-insured employee welfare benefit plan participants.

Terms To Know

Cost Sharing

The part of the cost for a health service that you pay when you get the service. It can include deductibles, copayments, and coinsurance.

Medically Necessary Diagnostic Breast Imaging

Tests or scans needed to diagnose breast cancer or other breast-related conditions after an abnormal mammogram result or for people with risk factors associated with breast cancer.

Limits and Unknowns

• The bill does not specify what happens if a health plan is issued, amended, or renewed before January 1, 2028.
• It does not provide details on how the coverage will be implemented for self-insured plans.

Official Summary Text

AB 1570, as amended, Wilson.
Health care coverage: diagnostic imaging.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract issued, amended, delivered, or renewed on or after January 1, 2000, or an individual or group policy of disability insurance or self-insured employee welfare benefit plan to provide coverage for mammography for screening or diagnostic purposes upon referral by specified professionals. Under existing law, mammography performed pursuant to those requirements or that meets the current recommendations of the United States Preventive Services Task Force is provided to an enrollee or an insured without cost
sharing.
This bill would require a health care service plan contract, a
policy of health insurance that provides hospital, medical, or surgical coverage,
health insurance policy,
or a self-insured employee welfare benefit plan issued, amended, or renewed on or after January 1, 2028, to provide coverage without imposing cost sharing for, among other things, screening mammography and medically necessary diagnostic breast imaging, including diagnostic breast imaging following an abnormal mammography result and for an enrollee or insured indicated to have a risk factor associated with breast cancer, except as specified.
The California Constitution requires the state to reimburse local agencies and school districts for
certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.

Current Bill Text

Download Bill PDF