H.F. 2489 Section 1. NEW SECTION . 514C.4A Supplemental and diagnostic 1 breast examinations. 2 1. As used in this section, unless the context otherwise 3 requires: 4 a. “Breast magnetic resonance imaging” or “breast MRI” 5 means an examination of a breast, following administration of 6 intravenous contrast, using a powerful magnetic field, radio 7 waves, and a computer to produce detailed pictures of the 8 structures within the breast. 9 b. “Breast ultrasound” means a noninvasive examination of 10 a breast using high-frequency sound waves to produce detailed 11 images of the breast. 12 c. “Covered person” means a policyholder, subscriber, or 13 other person participating in a policy, contract, or plan that 14 provides for third-party payment or prepayment of health or 15 medical expenses. 16 d. “Diagnostic breast examination” means a medically 17 necessary and appropriate examination of the breast that may 18 include a diagnostic mammogram, breast magnetic resonance 19 imaging, breast ultrasound, or other breast imaging, and that 20 is performed for any of the following reasons: 21 (1) To evaluate an abnormality seen or suspected during a 22 screening examination for breast cancer. 23 (2) To evaluate an abnormality detected by another means of 24 examination. 25 e. “Diagnostic mammogram” means a detailed examination of a 26 breast abnormality using X ray. 27 f. “Health care professional” means the same as defined in 28 section 514J.102. 29 g. “Health care services” means services for the diagnosis, 30 prevention, treatment, cure, or relief of a health condition, 31 illness, injury, or disease. 32 h. “Screening mammogram” means an examination of a breast 33 that aids in the early detection and diagnosis of breast 34 abnormalities including breast cancer. 35 -1- LSB 1437HV (3) 90 nls/ko 1/ 3

H.F. 2489 i. “Supplemental breast examination” means a medically 1 necessary and appropriate examination of the breast that may 2 include breast magnetic resonance imaging, breast ultrasound, 3 contrast-enhanced mammography, or examination for dense 4 breast tissue as described by the breast imaging reporting 5 and data system of the American college of radiology, and 6 that is performed to screen for breast cancer when there is 7 no abnormality seen or suspected and based on an individual’s 8 personal or family medical history, or additional factors that 9 may increase the individual’s risk of breast cancer. 10 2. a. Notwithstanding the uniformity of treatment 11 requirements of section 514C.6, a policy, contract, or plan 12 providing for third-party payment or prepayment of health or 13 medical expenses shall provide coverage for supplemental breast 14 examinations and diagnostic breast examinations. 15 b. Coverage required under this section shall not be less 16 favorable than coverage a health carrier offers for screening 17 mammograms. 18 3. a. This section applies to the following classes of 19 third-party payment provider contracts, policies, or plans 20 delivered, issued for delivery, continued, or renewed in this 21 state on or after January 1, 2025: 22 (1) Individual or group accident and sickness insurance 23 providing coverage on an expense-incurred basis. 24 (2) An individual or group hospital or medical service 25 contract issued pursuant to chapter 509, 514, or 514A. 26 (3) An individual or group health maintenance organization 27 contract regulated under chapter 514B. 28 (4) A plan established for public employees pursuant to 29 chapter 509A. 30 b. This section shall not apply to accident-only, specified 31 disease, short-term hospital or medical, hospital confinement 32 indemnity, credit, dental, vision, Medicare supplement, 33 long-term care, basic hospital and medical-surgical expense 34 coverage as defined by the commissioner of insurance, 35 -2- LSB 1437HV (3) 90 nls/ko 2/ 3

H.F. 2489 disability income insurance coverage, coverage issued as a 1 supplement to liability insurance, workers’ compensation or 2 similar insurance, or automobile medical payment insurance. 3 4. The commissioner of insurance may adopt rules pursuant to 4 chapter 17A to administer this section. 5 EXPLANATION 6 The inclusion of this explanation does not constitute agreement with 7 the explanation’s substance by the members of the general assembly. 8 This bill relates to insurance coverage for supplemental and 9 diagnostic breast examinations. 10 The bill requires a policy, contract, or plan providing 11 for third-party payment or prepayment of health or medical 12 expenses to provide coverage for diagnostic and supplemental 13 breast examinations. “Diagnostic breast examination” and 14 “supplemental breast examination” are defined in the bill. 15 “Diagnostic mammogram”, “breast magnetic resonance imaging”, 16 and “breast ultrasound” are also defined in the bill. 17 Coverage required under the bill shall not be less favorable 18 than coverage a health carrier offers for screening mammograms. 19 The bill applies to third-party payment providers enumerated 20 in the bill. The bill specifies the types of specialized 21 health-related insurance which are not subject to the coverage 22 requirements of the bill. 23 The commissioner of insurance may adopt rules to administer 24 the requirements of the bill. 25 -3- LSB 1437HV (3) 90 nls/ko 3/ 3