H.B. 191

1

HEALTH INSURANCE COVERAGE OF
2 MAMMOGRAPHY
3 2007 GENERAL SESSION
4 STATE OF UTAH
5 Chief Sponsor: Carol Spackman Moss
6 Senate Sponsor: ____________
7
8 LONG TITLE
9 General Description:
10 This bill requires health insurance providers to cover breast cancer screening
11 mammography.
12 Highlighted Provisions:
13 This bill:
14 . provides definitions;
15 . requires that health insurance policies and health maintenance organization
16 contracts cover breast cancer screening mammography according to a specified
17 schedule;
18 . prohibits greater cost sharing for breast cancer screening mammography than other
19 screening or diagnostic procedures; and
20 . grants rulemaking authority.
21 Monies Appropriated in this Bill:
22 None
23 Other Special Clauses:
24 None
25 Utah Code Sections Affected:
26 ENACTS:
27 31A-22-629.5, Utah Code Annotated 1953

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

Legislative Review Note
as of 11-16-06 10:21 AM

Office of Legislative Research and General Counsel