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HB598
HOUSE OF REPRESENTATIVES
H.B. NO.
598
THIRTY-THIRD LEGISLATURE, 2025
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 clinically appropriate
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 diagnostic mammography, breast magnetic resonance
imaging, or breast ultrasound.
����
"Supplemental breast
examination" means a medically necessary and appropriate 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 breast magnetic resonance imaging or breast
ultrasound.
"
����
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 clinically appropriate
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 diagnostic mammography, breast magnetic resonance
imaging, or breast ultrasound.
����
"Supplemental breast
examination" means a medically necessary and appropriate 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 breast magnetic resonance imaging or breast
ultrasound.
"
����
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 clinically appropriate
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 diagnostic mammography, breast magnetic resonance
imaging, or breast ultrasound.
����
"Supplemental breast
examination" means a medically necessary and appropriate 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 breast magnetic resonance imaging or breast
ultrasound.
"
����
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."
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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.
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SECTION
7
.
�
This Act shall
take effect on January 1, 2026, 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, 2026.
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.