H.F. 71 Section 1. NEW SECTION . 514C.4A Diagnostic examinations 1 —— breast cancer. 2 1. As used in this section, unless the context otherwise 3 requires: 4 a. “Abnormality” means an abnormal feature, characteristic, 5 or occurrence in a covered person’s breast that meets any of 6 the following requirements: 7 (1) The abnormality is identified as a result of a covered 8 person’s screening mammogram. 9 (2) The abnormality is identified during the provision 10 of health care services to a covered person by a health care 11 professional. 12 (3) A health care professional determines an abnormality 13 exists based on a covered person’s medical history or the 14 covered person’s family medical history. 15 b. “Breast magnetic resonance imaging” or “breast MRI” means 16 an examination of a breast using a powerful magnetic field, 17 radio waves, and a computer to produce detailed pictures of the 18 structures within the breast. 19 c. “Breast ultrasound” means a noninvasive examination of 20 a breast using high-frequency sound waves to produce detailed 21 images of the breast. 22 d. “Cost-sharing” means any coverage limit, copayment, 23 coinsurance, deductible, or other out-of-pocket expense 24 obligation imposed on a covered person by a policy, contract, 25 or plan providing for third-party payment or prepayment of 26 health or medical expenses. 27 e. “Covered person” means a policyholder, subscriber, or 28 other person participating in a policy, contract, or plan that 29 provides for third-party payment or prepayment of health or 30 medical expenses. 31 f. “Diagnostic breast cancer examination” means an 32 examination of an abnormality, deemed medically necessary and 33 appropriate by a covered person’s health care professional, 34 for the detection of breast cancer. The examination may 35 -1- LSB 1437YH (2) 90 ko/rn 1/ 4

H.F. 71 be conducted using a diagnostic mammogram, breast magnetic 1 resonance imaging, or a breast ultrasound. 2 g. “Diagnostic mammogram” means a detailed examination of a 3 breast abnormality using X ray. 4 h. “Health care professional” means the same as defined in 5 section 514J.102. 6 i. “Health care services” means services for the diagnosis, 7 prevention, treatment, cure, or relief of a health condition, 8 illness, injury, or disease. 9 j. “Screening mammogram” means an examination of a breast 10 that aids in the early detection and diagnosis of breast 11 cancer. 12 2. a. Notwithstanding the uniformity of treatment 13 requirements of section 514C.6, a policy, contract, or plan 14 providing for third-party payment or prepayment of health or 15 medical expenses shall provide coverage for diagnostic breast 16 cancer examinations. 17 b. Coverage required under this section shall not be less 18 favorable than coverage a health carrier offers for screening 19 mammograms. 20 c. Cost-sharing requirements imposed for coverage 21 required under this section shall not be less favorable than 22 cost-sharing requirements imposed by a health carrier for 23 screening mammograms. 24 3. a. This section applies to the following classes of 25 third-party payment provider contracts, policies, or plans 26 delivered, issued for delivery, continued, or renewed in this 27 state on or after January 1, 2024: 28 (1) Individual or group accident and sickness insurance 29 providing coverage on an expense-incurred basis. 30 (2) An individual or group hospital or medical service 31 contract issued pursuant to chapter 509, 514, or 514A. 32 (3) An individual or group health maintenance organization 33 contract regulated under chapter 514B. 34 (4) A plan established for public employees pursuant to 35 -2- LSB 1437YH (2) 90 ko/rn 2/ 4

H.F. 71 chapter 509A. 1 b. This section shall not apply to accident-only, specified 2 disease, short-term hospital or medical, hospital confinement 3 indemnity, credit, dental, vision, Medicare supplement, 4 long-term care, basic hospital and medical-surgical expense 5 coverage as defined by the commissioner of insurance, 6 disability income insurance coverage, coverage issued as a 7 supplement to liability insurance, workers’ compensation or 8 similar insurance, or automobile medical payment insurance. 9 4. The commissioner of insurance shall adopt rules pursuant 10 to chapter 17A to administer this section. 11 EXPLANATION 12 The inclusion of this explanation does not constitute agreement with 13 the explanation’s substance by the members of the general assembly. 14 This bill relates to insurance coverage for diagnostic 15 breast cancer examinations. 16 The bill requires a policy, contract, or plan providing for 17 third-party payment or prepayment of health or medical expenses 18 to provide coverage for diagnostic breast cancer examinations. 19 “Diagnostic breast cancer examination” is defined in the bill 20 as an examination of an abnormality, deemed medically necessary 21 by a covered person’s health care professional, for the 22 detection of breast cancer. The examination may be conducted 23 using a diagnostic mammogram, breast magnetic resonance 24 imaging, or breast ultrasound. “Abnormality”, “diagnostic 25 mammogram”, “breast magnetic resonance imaging”, and “breast 26 ultrasound” are also defined in the bill. 27 Coverage required under the bill shall not be less favorable 28 than coverage a health carrier offers for screening mammograms. 29 The policy, contract, or plan cannot impose cost-sharing 30 greater than the cost-sharing that the policy, contract, or 31 plan imposes for a screening mammogram. “Cost-sharing” and 32 “screening mammogram” are defined in the bill. 33 The bill applies to third-party payment providers enumerated 34 in the bill. The bill specifies the types of specialized 35 -3- LSB 1437YH (2) 90 ko/rn 3/ 4

H.F. 71 health-related insurance which are not subject to the coverage 1 requirements of the bill. 2 The commissioner of insurance is required to adopt rules to 3 administer the requirements of the bill. 4 The bill applies to third-party payment provider contracts, 5 policies, or plans delivered, issued for delivery, continued, 6 or renewed in this state on or after January 1, 2024. 7 -4- LSB 1437YH (2) 90 ko/rn 4/ 4