2017 -- H 5633

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LC001693

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2017

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Fogarty, Tanzi, Donovan, Carson, and Ranglin-Vassell

     Date Introduced: March 01, 2017

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-18-41 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

     27-18-41. Mammograms and pap smears -- Coverage mandated.

     (a) (1) Every individual or group hospital or medical expense insurance policy or

individual or group hospital or medical services plan contract delivered, issued for delivery, or

renewed in this state shall provide coverage for mammograms and pap smears, in accordance

with guidelines established by the American Cancer Society.

     (2) Notwithstanding the provisions of this chapter, every individual or group hospital or

medical insurance policy or individual or group hospital or medical services plan contract

delivered, issued for delivery, or renewed in this state shall pay the costs of breast ultrasound

screening and/or a breast MRI exam for any person who has received notice pursuant to §23-

12.9-2 of the existence of dense breast tissue, for two (2) screening mammograms per year when

recommended by a physician for women who have been treated for breast cancer within the last

five (5) years or are at high risk of developing breast cancer due to genetic predisposition (BRCA

gene mutation or multiple first degree relatives) or high risk lesion on prior biopsy (lobular

carcinoma in situ) or atypical ductal hyperplasia.

     (b) This section shall not apply to insurance coverage providing benefits for: (1) hospital

confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare

supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily

injury or death by accident or both; and (9) other limited benefit policies.

     SECTION 2. Section 27-19-20 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

     27-19-20. Mammograms and pap smears -- Coverage mandated.

     (a) Subscribers to any nonprofit hospital service plan shall be afforded coverage under

the plan for mammograms and pap smears, in accordance with guidelines established by the

American Cancer Society.

     (b) Notwithstanding the provisions of this chapter, subscribers to any nonprofit hospital

service plan shall be afforded coverage the costs of breast ultrasound screening and/or a breast

MRI exam for any person who has received notice pursuant to §23-12.9-2 of the existence of

dense breast tissue, for two (2) screening mammograms per year when recommended by a

physician for women who have been treated for breast cancer within the last five (5) years or who

are at high risk of developing breast cancer due to genetic predisposition (BRCA gene mutation

or multiple first degree relatives) or high risk lesion on prior biopsy (lobular carcinoma in situ) or

atypical ductal hyperplasia.

     SECTION 3. Section 27-20-17 of the General Laws in Chapter 27-20 entitled "Nonprofit

Medical Service Corporations" is hereby amended to read as follows:

     27-20-17. Mammograms and pap smears -- Coverage mandated.

     (a) Subscribers to any nonprofit medical service plan shall be afforded coverage under

the plan for mammograms and pap smears, in accordance with guidelines established by the

American Cancer Society.

     (b) Notwithstanding the provisions of this chapter, subscribers to any nonprofit medical

service plan shall be afforded coverage the costs of breast ultrasound screening and/or a breast

MRI exam for any person who has received notice pursuant to §23-12.9-2 of the existence of

dense breast tissue, for two (2) paid screening mammograms per year when recommended by a

physician for women who have been treated for breast cancer within the last five (5) years or who

are at high risk of developing breast cancer due to genetic predisposition (BRCA gene mutation

or multiple first degree relatives) or high risk lesion on prior biopsy (lobular carcinoma in situ) or

atypical ductal hyperplasia.

     SECTION 4. Section 27-41-30 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

     27-41-30. Mammograms and pap smears -- Coverage mandated.

     (a) Subscribers to any health maintenance organization plan shall be afforded coverage

under that plan for mammograms and pap smears, in accordance with guidelines established by

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the American Cancer Society.

     (b) Notwithstanding the provisions of this chapter, subscribers to any health maintenance

organization plan shall be afforded coverage the costs of breast ultrasound screening and/or a

breast MRI exam for any person who has received notice pursuant to §23-12.9-2 of the existence

of dense breast tissue, for two (2) paid screening mammograms per year when recommended by a

physician for women who have been treated for breast cancer within the last five (5) years or who

are at high risk of developing breast cancer due to genetic predisposition (BRCA gene mutation

or multiple first degree relatives) or high risk lesion on prior biopsy (lobular carcinoma in situ) or

atypical ductal hyperplasia.

     SECTION 5. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

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     This act would require insurance carriers, nonprofit hospital service plans, nonprofit

medical service corporations and health maintenance organizations to cover the costs of breast

ultrasounds and/or MRI breast exams for any person receiving notice of dense breast tissue

pursuant to §23-12.9-2.

     This act would take effect upon passage.

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