Senate Study Bill 3135 - Introduced SENATE FILE _____ BY (PROPOSED COMMITTEE ON COMMERCE BILL BY CHAIRPERSON BROWN) A BILL FOR An Act relating to insurance coverage for supplemental and 1 diagnostic breast examinations. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 5676XC (5) 90 nls/ko

S.F. _____ 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. “Cost-sharing” means any coverage limit, copayment, 13 coinsurance, deductible, or other out-of-pocket expense 14 obligation imposed on a covered person by a policy, contract, 15 or plan providing for third-party payment or prepayment of 16 health or medical expenses. 17 d. “Covered person” means a policyholder, subscriber, or 18 other person participating in a policy, contract, or plan that 19 provides for third-party payment or prepayment of health or 20 medical expenses. 21 e. “Diagnostic breast examination” means a medically 22 necessary and appropriate examination of the breast that may 23 include a diagnostic mammogram, breast magnetic resonance 24 imaging, breast ultrasound, or other breast imaging, and that 25 is performed for any of the following reasons: 26 (1) To evaluate an abnormality seen or suspected during a 27 screening examination for breast cancer. 28 (2) To evaluate an abnormality detected by another means of 29 examination. 30 f. “Diagnostic mammogram” means a detailed examination of a 31 breast abnormality using X ray. 32 g. “Health care professional” means the same as defined in 33 section 514J.102. 34 h. “Health care services” means services for the diagnosis, 35 -1- LSB 5676XC (5) 90 nls/ko 1/ 4

S.F. _____ prevention, treatment, cure, or relief of a health condition, 1 illness, injury, or disease. 2 i. “Screening mammogram” means an examination of a breast 3 that aids in the early detection and diagnosis of breast 4 abnormalities including breast cancer. 5 j. “Supplemental breast examination” means a medically 6 necessary and appropriate examination of the breast that may 7 include breast magnetic resonance imaging, breast ultrasound, 8 contrast-enhanced mammography, or examination for dense 9 breast tissue as described by the breast imaging reporting 10 and data system of the American college of radiology, and 11 that is performed to screen for breast cancer when there is 12 no abnormality seen or suspected and based on an individual’s 13 personal or family medical history, or additional factors that 14 may increase the individual’s risk of breast cancer. 15 2. a. Notwithstanding the uniformity of treatment 16 requirements of section 514C.6, a policy, contract, or plan 17 providing for third-party payment or prepayment of health or 18 medical expenses shall provide coverage for supplemental breast 19 examinations and diagnostic breast examinations. 20 b. Coverage required under this section shall not be less 21 favorable than coverage a health carrier offers for screening 22 mammograms. 23 c. Cost-sharing requirements shall not be imposed by a 24 health carrier for coverage required under this section. 25 3. a. This section applies to the following classes of 26 third-party payment provider contracts, policies, or plans 27 delivered, issued for delivery, continued, or renewed in this 28 state on or after January 1, 2025: 29 (1) Individual or group accident and sickness insurance 30 providing coverage on an expense-incurred basis. 31 (2) An individual or group hospital or medical service 32 contract issued pursuant to chapter 509, 514, or 514A. 33 (3) An individual or group health maintenance organization 34 contract regulated under chapter 514B. 35 -2- LSB 5676XC (5) 90 nls/ko 2/ 4

S.F. _____ (4) A plan established for public employees pursuant to 1 chapter 509A. 2 b. This section shall not apply to accident-only, specified 3 disease, short-term hospital or medical, hospital confinement 4 indemnity, credit, dental, vision, Medicare supplement, 5 long-term care, basic hospital and medical-surgical expense 6 coverage as defined by the commissioner of insurance, 7 disability income insurance coverage, coverage issued as a 8 supplement to liability insurance, workers’ compensation or 9 similar insurance, or automobile medical payment insurance. 10 4. The commissioner of insurance may adopt rules pursuant to 11 chapter 17A to administer this section. 12 EXPLANATION 13 The inclusion of this explanation does not constitute agreement with 14 the explanation’s substance by the members of the general assembly. 15 This bill relates to insurance coverage for supplemental 16 breast examinations (supplemental examinations) and diagnostic 17 breast examinations (diagnostic examinations). 18 The bill requires a policy, contract, or plan providing 19 for third-party payment or prepayment of health or medical 20 expenses to provide coverage for supplemental examinations 21 and diagnostic examinations. “Supplemental examination” and 22 “diagnostic examination” are defined in the bill. Coverage 23 required under the bill shall not be less favorable than 24 coverage a health carrier offers for screening mammograms. The 25 health carrier shall not impose cost-sharing for supplemental 26 examinations or diagnostic examinations. “Cost-sharing” and 27 “screening mammogram” are defined in the bill. 28 The bill applies to the third-party payment providers 29 enumerated in the bill. The bill specifies the types of 30 specialized health-related insurance which are not subject to 31 the coverage requirements of the bill. 32 The commissioner of insurance may adopt rules to administer 33 the requirements of the bill. 34 The provisions of the bill are applicable to third-party 35 -3- LSB 5676XC (5) 90 nls/ko 3/ 4

S.F. _____ payment provider contracts, policies, or plans delivered, 1 issued for delivery, continued, or renewed in this state on or 2 after January 1, 2025. 3 -4- LSB 5676XC (5) 90 nls/ko 4/ 4