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HB2366
HOUSE OF REPRESENTATIVES
H.B. NO.
2366
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII
A BILL FOR AN ACT
relating
to health
.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
����
SECTION
1
.
�
Chapter 431, Hawaii Revised Statutes, is
amended by adding a new section to article 10A to be appropriately designated
and to read as follows:
����
"
�431:10A-
�
��
Breast
cancer screening, supplemental breast examinations, and diagnostic breast
examinations; cost-sharing prohibited.
�
(a)
�
No individual or group accident and health or
sickness insurance policy that provides coverage for breast cancer screening,
supplemental breast examinations, or diagnostic breast examinations shall
impose any cost-sharing requirements on the insured,
except to
the extent that coverage of particular services without cost-sharing would
disqualify an individual covered under a high deductible health plan from being
considered an eligible individual pursuant to section 223 of the Internal
Revenue Code of 1986, as amended.
�
For an
individual covered under a high deductible health plan, the insurer shall
establish the plan's cost-sharing for the coverage provided pursuant to this
section at the minimum level necessary to preserve the insured's eligibility
under section 223 of the Internal Revenue Code of 1986, as amended
; provided that, for items or services that
are considered preventative care pursuant to
section 223(c)(2)(C) of the
Internal Revenue Code of 1986, as amended
, the requirements of this subsection shall apply regardless of whether
the minimum deductible under
section 223(c)(2)(A) of the Internal
Revenue Code of 1986, as amended,
has
been satisfied.
����
(b)
�
As used in this section:
����
"Cost-sharing
requirement" includes a deductible, a coinsurance, a copayment, and any
maximum limitation on the application of the deductible, coinsurance,
copayment, or similar out-of-pocket expense.
����
"Diagnostic
breast examination" means a medically necessary and appropriate, in
accordance with National Comprehensive Cancer Network Guidelines, examination
of the breast that is:
����
(1)
�
Used to evaluate an abnormality seen
or suspected from a screening examination for breast cancer; or
����
(2)
�
Used to evaluate an abnormality
detected by another means of examination.
"Diagnostic
breast examination" includes an examination using contrast-enhanced
mammography, diagnostic mammography, breast magnetic resonance imaging, breast
ultrasound, or molecular breast imaging.
����
"Supplemental
breast examination" means a medically necessary and appropriate, in
accordance with National Comprehensive Cancer Network Guidelines, examination
of the breast that is:
����
(1)
�
Used to screen for breast cancer in
the absence of an abnormality being seen or suspected; and
����
(2)
�
Based on personal or family medical
history or any additional factors that may increase the individual's risk of
breast cancer.
"Supplemental
breast examination" includes an examination using contrast-enhanced
mammography, diagnostic mammography, breast magnetic resonance imaging, breast
ultrasound, or molecular breast imaging.
"
����
SECTION
2.
�
Chapter 432, Hawaii Revised Statutes,
is amended by adding a new section to article 1 to be appropriately designated
and to read as follows:
����
"
�432:1-
�
��
Breast cancer screening,
supplemental breast examinations, and diagnostic breast examinations;
cost-sharing prohibited.
�
(a)
�
No individual or group hospital or medical service plan contract that
provides coverage for breast cancer screening, supplemental breast
examinations, or diagnostic breast examinations shall impose any cost-sharing
requirements on the insured,
except to the extent that coverage
of particular services without cost-sharing would disqualify an individual
covered under a high deductible health plan from being considered an eligible
individual pursuant to section 223 of the Internal Revenue Code of 1986, as
amended.
�
For an individual covered under
a high deductible health plan, the insurer shall establish the plan's
cost-sharing for the coverage provided pursuant to this section at the minimum
level necessary to preserve the insured's eligibility under section 223 of the
Internal Revenue Code of 1986, as amended
; provided that, for items or services that are considered preventative
care pursuant to
section 223(c)(2)(C) of the Internal Revenue Code of
1986, as amended
, the requirements of
this subsection shall apply regardless of whether the minimum deductible under
section 223(c)(2)(A)
of the Internal Revenue Code of 1986, as amended,
has been satisfied.
����
(b)
�
As used in this section:
����
"Cost-sharing
requirement" includes a deductible, a coinsurance, a copayment, and any
maximum limitation on the application of the deductible, coinsurance,
copayment, or similar out-of-pocket expense.
����
"Diagnostic
breast examination" means a medically necessary and appropriate, in
accordance with National Comprehensive Cancer Network Guidelines, examination
of the breast that is:
����
(1)
�
Used to evaluate an abnormality seen
or suspected from a screening examination for breast cancer; or
����
(2)
�
Used to evaluate an abnormality
detected by another means of examination.
"Diagnostic
breast examination" includes an examination using contrast-enhanced
mammography, diagnostic mammography, breast magnetic resonance imaging, breast
ultrasound, or molecular breast imaging.
����
"Supplemental
breast examination" means a medically necessary and appropriate, in
accordance with National Comprehensive Cancer Network Guidelines, examination
of the breast that is:
����
(1)
�
Used to screen for breast cancer in
the absence of an abnormality being seen or suspected; and
����
(2)
�
Based on personal or family medical
history or any additional factors that may increase the individual's risk of
breast cancer.
"Supplemental
breast examination" includes an examination using contrast-enhanced
mammography, diagnostic mammography, breast magnetic resonance imaging, breast
ultrasound, or molecular breast imaging.
"
����
SECTION
3.
�
Chapter 432D, Hawaii Revised
Statutes, is amended by adding a new section to be appropriately designated and
to read as follows:
����
"
�432D-
�
��
Breast cancer screening,
supplemental breast examinations, and diagnostic breast examinations;
cost-sharing prohibited.
�
(a)
�
No health maintenance organization policy, contract, plan, or agreement that
provides coverage for breast cancer screening, supplemental breast
examinations, or diagnostic breast examinations shall impose any cost-sharing
requirements on the insured,
except to the extent that coverage
of particular services without cost-sharing would disqualify an individual
covered under a high deductible health plan from being considered an eligible
individual pursuant to section 223 of the Internal Revenue Code of 1986, as
amended.
�
For an individual covered under
a high deductible health plan, the insurer shall establish the plan's
cost-sharing for the coverage provided pursuant to this section at the minimum
level necessary to preserve the insured's eligibility under section 223 of the
Internal Revenue Code of 1986, as amended
; provided that, for items or services that are considered preventative
care pursuant to
section 223(c)(2)(C) of the Internal Revenue Code of
1986, as amended
, the requirements of
this subsection shall apply regardless of whether the minimum deductible under
section 223(c)(2)(A)
of the Internal Revenue Code of 1986, as amended,
has been satisfied.
����
(b)
�
As used in this section:
����
"Cost-sharing
requirement" includes a deductible, a coinsurance, a copayment, and any
maximum limitation on the application of the deductible, coinsurance,
copayment, or similar out-of-pocket expense.
����
"Diagnostic
breast examination" means a medically necessary and appropriate, in
accordance with National Comprehensive Cancer Network Guidelines, examination
of the breast that is:
����
(1)
�
Used to evaluate an abnormality seen
or suspected from a screening examination for breast cancer; or
����
(2)
�
Used to evaluate an abnormality
detected by another means of examination.
"Diagnostic
breast examination" includes an examination using contrast-enhanced
mammography, diagnostic mammography, breast magnetic resonance imaging, breast
ultrasound, or molecular breast imaging.
����
"Supplemental
breast examination" means a medically necessary and appropriate, in
accordance with National Comprehensive Cancer Network Guidelines, examination
of the breast that is:
����
(1)
�
Used to screen for breast cancer in
the absence of an abnormality being seen or suspected; and
����
(2)
�
Based on personal or family medical
history or any additional factors that may increase the individual's risk of
breast cancer.
"Supplemental
breast examination" includes an examination using contrast-enhanced
mammography, diagnostic mammography, breast magnetic resonance imaging, breast
ultrasound, or molecular breast imaging.
"
����
SECTION
4
.
�
Section
431:10A-116, Hawaii Revised Statutes, is amended to read as follows:
����
"
�431:10A-116
�
Coverage for specific services.
�
Every person insured under a policy of
accident and health or sickness insurance delivered or issued for delivery in
this State shall be entitled to the reimbursements and coverages specified
below:
����
(1)
�
Notwithstanding any provision to the
contrary, whenever a policy, contract, plan, or agreement provides for
reimbursement for any visual or optometric service, which is within the lawful
scope of practice of a duly licensed optometrist, the person entitled to
benefits or the person performing the services shall be entitled to
reimbursement whether the service is performed by a licensed physician or by a
licensed optometrist.
�
Visual or
optometric services shall include eye or visual examination, or both, or a
correction of any visual or muscular anomaly, and the supplying of ophthalmic
materials, lenses, contact lenses, spectacles, eyeglasses, and appurtenances
thereto;
����
(2)
�
Notwithstanding any provision to the
contrary, for all policies, contracts, plans, or agreements issued on or after
May 30, 1974, whenever provision is made for reimbursement or indemnity for any
service related to surgical or emergency procedures, which is within the lawful
scope of practice of any practitioner licensed to practice medicine in this
State, reimbursement or indemnification under the policy, contract, plan, or
agreement shall not be denied when the services are performed by a dentist acting
within the lawful scope of the dentist's license;
����
(3)
�
Notwithstanding any provision to the
contrary, whenever the policy provides reimbursement or payment for any
service, which is within the lawful scope of practice of a psychologist
licensed in this State, the person entitled to benefits or performing the
service shall be entitled to reimbursement or payment, whether the service is
performed by a licensed physician or licensed psychologist;
����
(4)
�
Notwithstanding any provision to the
contrary, each policy, contract, plan, or agreement issued on or after February
1, 1991, except for policies that only provide coverage for specified diseases
or other limited benefit coverage, but including policies issued by companies
subject to chapter 431, article 10A, part II and chapter 432, article 1 shall
provide coverage for screening by low-dose mammography for occult breast cancer
as follows:
���������
(A)
�
For women forty years of age and older,
an annual mammogram; and
���������
(B)
�
For a woman of any age with a history
of breast cancer or whose mother or sister has had a history of breast cancer,
a mammogram upon the recommendation of the woman's physician.
�������������
[
The
]
Except as otherwise provided for in section 431:10A-
��
, the
services provided in this
paragraph are subject to any coinsurance provisions that may be in force in
these policies, contracts, plans, or agreements.
�������������
For
the purpose of this paragraph, the term "low‑dose mammography"
means the x-ray examination of the breast using equipment dedicated
specifically for mammography, including but not limited to the x-ray tube,
filter, compression device, screens, films, and cassettes, with an average
radiation exposure delivery of less than one rad mid-breast, with two views for
each breast.
�
An insurer may provide the
services required by this paragraph through contracts with providers; provided
that the contract is determined to be a cost-effective means of delivering the
services without sacrifice of quality and meets the approval of the director of
health; and
����
(5)
�
(A)
�
(i)
�
Notwithstanding any provision to the
contrary, whenever a policy, contract, plan, or agreement provides coverage for
the children of the insured, that coverage shall also extend to the date of
birth of any newborn child to be adopted by the insured; provided that the
insured gives written notice to the insurer of the insured's intent to adopt
the child prior to the child's date of birth or within thirty days after the
child's birth or within the time period required for enrollment of a natural
born child under the policy, contract, plan, or agreement of the insured,
whichever period is longer; provided further that if the adoption proceedings
are not successful, the insured shall reimburse the insurer for any expenses
paid for the child; and
������������
(ii)
�
Where notification has not been
received by the insurer prior to the child's birth or within the specified
period following the child's birth, insurance coverage shall be effective from
the first day following the insurer's receipt of legal notification of the
insured's ability to consent for treatment of the infant for whom coverage is
sought; and
���������
(B)
�
When the insured is a member of a
health maintenance organization, coverage of an adopted newborn is effective:
�������������
(i)
�
From the date of birth of the adopted
newborn when the newborn is treated from birth pursuant to a provider contract
with the health maintenance organization, and written notice of enrollment in
accord with the health maintenance organization's usual enrollment process is
provided within thirty days of the date the insured notifies the health
maintenance organization of the insured's intent to adopt the infant for whom
coverage is sought; or
������������
(ii)
�
From the first day following receipt by
the health maintenance organization of written notice of the insured's ability
to consent for treatment of the infant for whom coverage is sought and
enrollment of the adopted newborn in accord with the health maintenance
organization's usual enrollment process if the newborn has been treated from
birth by a provider not contracting or affiliated with the health maintenance
organization."
����
SECTION
5
.
�
Section
432:1-605, Hawaii Revised Statutes, is amended by amending subsection (b) to
read as follows:
����
"(b)
�
[
The
]
Except as
otherwise provided for in section 432:1-
��
, the
services provided in subsection (a) are subject to any
coinsurance provisions that may be in force in these policies, contracts,
plans, or agreements."
����
SECTION
6
.
�
Statutory
material to be repealed is bracketed and stricken.
�
New statutory material is underscored.
����
SECTION
7
.
�
This Act shall
take effect on January 1, 2027, and shall apply to all plans, policies,
contracts, and agreements of health insurance issued or renewed by a health
insurer, mutual benefit society, or health maintenance organization on or after
January 1, 2027.
INTRODUCED BY:
_____________________________
Report Title:
Health
Care; Insurance; Coverage; Breast Cancer Screenings; Breast Examinations;
Cost-Sharing Prohibited
Description:
Prohibits
the imposition of cost-sharing requirements for certain diagnostic and
supplemental breast examinations.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.