AN ACT RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES (Prohibits an insurance company from imposing any cost-sharing requirements for any diagnostic or supplemental breast examinations.)

H7276

2026 -- H 7276
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LC004401
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STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
____________
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

Introduced By:
Representatives Fogarty, Carson, McGaw, Boylan, Furtado, Messier,
Shallcross Smith, Cruz, Potter, and Donovan

Date Introduced:
January 23, 2026

Referred To:
House Health & Human Services
It is enacted by the General Assembly as follows:
1
SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance
2
Policies" is hereby amended by adding thereto the following section:
3

27-18-42.1. Diagnostic and supplemental breast examination.

4

(a) As used in this section, the following words shall have the following meanings:
5

(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any
6
maximum limitation on the application of such a deductible, coinsurance, copayment or similar
7
out-of-pocket expense.
8

(2) "Diagnostic breast examinations" means a medically necessary and appropriate
9
examination of the breast, including an examination using diagnostic mammography, breast
10
magnetic resonance imaging, or breast ultrasound, that is:
11

(i) Used to evaluate an abnormality seen or suspected from a screening examination for
12
breast cancer; or
13

(ii) Used to evaluate an abnormality detected by another means of examination.
14

(3) "Supplemental breast examinations" means a medically necessary and appropriate
15
examination of the breast, including an examination using breast magnetic resonance imaging, or
16
breast ultrasound, that is:
17

(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and
18

(ii) Based on personal or family medical history, or additional factors that may increase the
19
individual’s risk of breast cancer.

1

(b) In the case that a group health plan, or a health insurance issuer offering group or
2
individual health insurance coverage, that provides benefits with respect to screening, supplemental
3
and diagnostic breast examinations furnished to an individual enrolled under such plan or such
4
coverage, the plan or coverage shall not impose any cost-sharing requirements.
5
SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service
6
Corporations" is hereby amended by adding thereto the following section:
7

27-19-34.2. Diagnostic and supplemental breast examination.

8

(a) As used in this section, the following words shall have the following meanings:
9

(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any
10
maximum limitation on the application of such a deductible, coinsurance, copayment or similar
11
out-of-pocket expense.
12

(2) "Diagnostic breast examinations" means a medically necessary and appropriate
13
examination of the breast, including an examination using diagnostic mammography, breast
14
magnetic resonance imaging, or breast ultrasound, that is:
15

(i) Used to evaluate an abnormality seen or suspected from a screening examination for
16
breast cancer; or
17

(ii) Used to evaluate an abnormality detected by another means of examination.
18

(3) "Supplemental breast examinations" means a medically necessary and appropriate
19
examination of the breast, including an examination using breast magnetic resonance imaging, or
20
breast ultrasound, that is:
21

(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and
22

(ii) Based on personal or family medical history, or additional factors that may increase the
23
individual’s risk of breast cancer.
24

(b) In the case that a group health plan, or a health insurance issuer offering group or
25
individual health insurance coverage, that provides benefits with respect to screening, supplemental
26
and diagnostic breast examinations furnished to an individual enrolled under such plan or such
27
coverage, the plan or coverage shall not impose any cost-sharing requirements.
28
SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service
29
Corporations" is hereby amended by adding thereto the following section:
30

27-20-17.2. Diagnostic and supplemental breast examination.

31

(a) As used in this section, the following words shall have the following meanings:
32

(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any
33
maximum limitation on the application of such a deductible, coinsurance, copayment or similar
34
out-of-pocket expense.

LC004401 - Page 2 of 5
1

(2) "Diagnostic breast examinations" means a medically necessary and appropriate
2
examination of the breast, including an examination using diagnostic mammography, breast
3
magnetic resonance imaging, or breast ultrasound, that is:
4

(i) Used to evaluate an abnormality seen or suspected from a screening examination for
5
breast cancer; or
6

(ii) Used to evaluate an abnormality detected by another means of examination.
7

(3) "Supplemental breast examinations" means a medically necessary and appropriate
8
examination of the breast, including an examination using breast magnetic resonance imaging, or
9
breast ultrasound, that is:
10

(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and
11

(ii) Based on personal or family medical history, or additional factors that may increase the
12
individual’s risk of breast cancer.
13

(b) In the case that a group health plan, or a health insurance issuer offering group or
14
individual health insurance coverage, that provides benefits with respect to screening, supplemental
15
and diagnostic breast examinations furnished to an individual enrolled under such plan or such
16
coverage, the plan or coverage shall not impose any cost-sharing requirements.
17
SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance
18
Organizations" is hereby amended by adding thereto the following section:
19

27-41-30.2. Diagnostic and supplemental breast examination.

20

(a) As used in this section, the following words shall have the following meanings:
21

(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any
22
maximum limitation on the application of such a deductible, coinsurance, copayment or similar
23
out-of-pocket expense.
24

(2) "Diagnostic breast examinations" means a medically necessary and appropriate
25
examination of the breast, including an examination using diagnostic mammography, breast
26
magnetic resonance imaging, or breast ultrasound, that is:
27

(i) Used to evaluate an abnormality seen or suspected from a screening examination for
28
breast cancer; or
29

(ii) Used to evaluate an abnormality detected by another means of examination.
30

(3) "Supplemental breast examinations" means a medically necessary and appropriate
31
examination of the breast, including an examination using breast magnetic resonance imaging, or
32
breast ultrasound, that is:
33

(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and
34

(ii) Based on personal or family medical history, or additional factors that may increase the

LC004401 - Page 3 of 5
1
individual’s risk of breast cancer.
2

(b) In the case that a group health plan, or a health insurance issuer offering group or
3
individual health insurance coverage, that provides benefits with respect to screening, supplemental
4
and diagnostic breast examinations furnished to an individual enrolled under such plan or such
5
coverage, the plan or coverage shall not impose any cost-sharing requirements.
6
SECTION 5. This act shall take effect on January 1, 2027.
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
***
1
This act would prohibit an insurance company from imposing any cost-sharing
2
requirements for any diagnostic or supplemental breast examinations.
3
This act would take effect on January 1, 2027.
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LC004401 - Page 5 of 5