H.B. 332

1

MAMMOGRAPHY INSURANCE COVERAGE
2 2006 GENERAL SESSION
3 STATE OF UTAH
4 Chief Sponsor: Carol Spackman Moss
5 Senate Sponsor: ____________
6
7 LONG TITLE
8 General Description:
9 This bill requires health insurance providers to cover breast cancer screening
10 mammography.
11 Highlighted Provisions:
12 This bill:
13 . provides definitions;
14 . requires that health insurance policies and health maintenance organization
15 contracts cover breast cancer screening mammography according to a specified
16 schedule;
17 . prohibits greater cost sharing for breast cancer screening mammography than other
18 screening or diagnostic procedures; and
19 . grants rulemaking authority.
20 Monies Appropriated in this Bill:
21 None
22 Other Special Clauses:
23 None
24 Utah Code Sections Affected:
25 ENACTS:
26 31A-22-629.5, Utah Code Annotated 1953
27

28 Be it enacted by the Legislature of the state of Utah:
29 Section 1. Section 31A-22-629.5 is enacted to read:
30 31A-22-629.5. Coverage of breast cancer screening mammography.
31 (1) As used in this section:
32 (a) "breast cancer screening mammography" has the same meaning as defined in Title
33 26, Chapter 21a, Breast Cancer; and
34 (b) "woman at risk" means a woman:
35 (i) who has a personal history of breast cancer;
36 (ii) who has a personal history of biopsy proven benign breast disease;
37 (iii) whose grandmother, mother, sister, or daughter has had breast cancer; or
38 (iv) who otherwise has a particular risk of breast cancer, as determined by department
39 rule.
40 (2) An individual or group health insurance policy or health maintenance organization
41 contract shall provide coverage for breast cancer screening mammography according to the
42 following schedule:
43 (a) once each year for a woman who is at least 40 years of age; and
44 (b) anytime when screening is ordered by a physician for a woman at risk.
45 (3) Coverage under Subsection (2):
46 (a) includes interpretation of the mammography results;
47 (b) does not include diagnostic mammography performed on a woman suspected of
48 having breast cancer; and
49 (c) may not include copays, deductibles, coinsurance, or other provisions that would
50 require greater cost sharing by the insured for the coverage of breast cancer screening
51 mammography than for the screening or diagnosis of other medical conditions.
52 (4) The commissioner:
53 (a) as necessary, shall make rules to implement the provisions of this section; and
54 (b) may, by rule, modify the definitions under Subsection (1) and the coverage
55 schedule under Subsection (2) pursuant to changes in cancer detection guidelines or practice
56 standards established by the American Cancer Society or other reputable organizations.

Legislative Review Note
as of 1-12-06 2:53 PM

Based on a limited legal review, this legislation has not been determined to have a high
probability of being held unconstitutional.

Office of Legislative Research and General Counsel